Provider Demographics
NPI:1689947707
Name:GILLIGAN, LUCINDA (PA)
Entity Type:Individual
Prefix:
First Name:LUCINDA
Middle Name:
Last Name:GILLIGAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-1632
Mailing Address - Country:US
Mailing Address - Phone:860-242-4439
Mailing Address - Fax:
Practice Address - Street 1:335 BROAD ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4036
Practice Address - Country:US
Practice Address - Phone:860-293-3101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001075363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant