Provider Demographics
NPI:1760629448
Name:MCALLISTER, MARCI ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:MARCI
Middle Name:ANNE
Last Name:MCALLISTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARCI
Other - Middle Name:ANNE
Other - Last Name:COOKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 ASYLUM AVE
Mailing Address - Street 2:SUITE 2126
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1770
Mailing Address - Country:US
Mailing Address - Phone:860-728-6740
Mailing Address - Fax:860-547-1554
Practice Address - Street 1:1000 ASYLUM AVE
Practice Address - Street 2:SUITE 2126
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1770
Practice Address - Country:US
Practice Address - Phone:860-728-6740
Practice Address - Fax:860-547-1554
Is Sole Proprietor?:No
Enumeration Date:2009-01-16
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002209363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical