Provider Demographics
NPI:1508042664
Name:KING, DEBRA AUGUST (PA, PHD)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:AUGUST
Last Name:KING
Suffix:
Gender:F
Credentials:PA, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 208058
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520-8058
Mailing Address - Country:US
Mailing Address - Phone:203-737-7652
Mailing Address - Fax:203-785-4043
Practice Address - Street 1:800 HOWARD AVE FL 3
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1369
Practice Address - Country:US
Practice Address - Phone:203-737-4652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005445363AS0400X
CT548363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical