Provider Demographics
NPI:1952456980
Name:MCMURRER-TROY, ALLENE B (PA)
Entity Type:Individual
Prefix:
First Name:ALLENE
Middle Name:B
Last Name:MCMURRER-TROY
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 1:22 OLD WATERBURY RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-3848
Mailing Address - Country:US
Mailing Address - Phone:203-262-4250
Mailing Address - Fax:
Practice Address - Street 1:22 OLD WATERBURY RD
Practice Address - Street 2:SUITE 204
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-3848
Practice Address - Country:US
Practice Address - Phone:203-262-4250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000899363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT29247OtherCONTROLLED SUBSTANCE REGI
CT29247OtherCONTROLLED SUBSTANCE REGI