Provider Demographics
NPI:1851373658
Name:MARRIOTT, PATRICIA MARIE (PA-C, MPAS)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:MARIE
Last Name:MARRIOTT
Suffix:
Gender:F
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1579 STRAITS TPKE
Mailing Address - Street 2:SUITE E
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-1835
Mailing Address - Country:US
Mailing Address - Phone:203-598-0700
Mailing Address - Fax:203-598-0076
Practice Address - Street 1:1579 STRAITS TPKE
Practice Address - Street 2:SUITE E
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-1835
Practice Address - Country:US
Practice Address - Phone:203-598-0700
Practice Address - Fax:206-598-0076
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT000036363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S8246Medicare UPIN