Provider Demographics
NPI:1740594282
Name:BETH, ELLEN HOLBROOK (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:HOLBROOK
Last Name:BETH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:135 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-1914
Mailing Address - Country:US
Mailing Address - Phone:860-357-6899
Mailing Address - Fax:860-357-6898
Practice Address - Street 1:135 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-1914
Practice Address - Country:US
Practice Address - Phone:860-357-6899
Practice Address - Fax:860-357-6898
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA4001363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant