Provider Demographics
NPI:1790270825
Name:LEBEL, TIMOTHY RAYMOND (PA-C)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:RAYMOND
Last Name:LEBEL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:TIM
Other - Middle Name:
Other - Last Name:LEBEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:77 JENIFORD RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-4026
Mailing Address - Country:US
Mailing Address - Phone:203-509-4942
Mailing Address - Fax:
Practice Address - Street 1:1579 STRAITS TPKE
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-1835
Practice Address - Country:US
Practice Address - Phone:203-509-4942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-01
Last Update Date:2018-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1142138363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant