Provider Demographics
NPI:1336601616
Name:RAGOZZINO, BRANDON RAYMOND (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:RAYMOND
Last Name:RAGOZZINO
Suffix:
Gender:M
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 1:1313 AVON BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-3608
Mailing Address - Country:US
Mailing Address - Phone:203-927-3702
Mailing Address - Fax:
Practice Address - Street 1:1 BUCKLAND RD STE 7
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-3764
Practice Address - Country:US
Practice Address - Phone:860-698-4301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4372363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant