Provider Demographics
NPI:1295710770
Name:LEMEK, BETH A (PA-C)
Entity type:Individual
Prefix:MS
First Name:BETH
Middle Name:A
Last Name:LEMEK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2139 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-2336
Mailing Address - Country:US
Mailing Address - Phone:860-257-4131
Mailing Address - Fax:860-257-4519
Practice Address - Street 1:2400 TAMARACK AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-5539
Practice Address - Country:US
Practice Address - Phone:860-644-4442
Practice Address - Fax:860-644-1412
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000985363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2V1755OtherHEALTHNET
CT090985OtherCONNECTICARE
CT2V1755OtherHEALTHNET
CTP72931Medicare UPIN