Provider Demographics
NPI:1649057043
Name:CALLEGARI, MARIA AGUSTINA (PA-C)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:AGUSTINA
Last Name:CALLEGARI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AGUSTINA
Other - Middle Name:
Other - Last Name:CALLEGARI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:19 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-2705
Mailing Address - Country:US
Mailing Address - Phone:603-476-9718
Mailing Address - Fax:606-386-8318
Practice Address - Street 1:1 SHAWS CV
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4902
Practice Address - Country:US
Practice Address - Phone:860-447-8304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61486486363A00000X
WAPA61486486363A00000X
CT6899363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant