Provider Demographics
NPI:1700256187
Name:BAXTER, MARYKATE (PA-C)
Entity Type:Individual
Prefix:
First Name:MARYKATE
Middle Name:
Last Name:BAXTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARY-KATE
Other - Middle Name:
Other - Last Name:ALMEIDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1290 SILAS DEANE HWY
Mailing Address - Street 2:HARTFORD HEALTHCARE-CVO
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4337
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:80 SEYMOUR ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06102-8000
Practice Address - Country:US
Practice Address - Phone:860-972-4166
Practice Address - Fax:860-545-0500
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3460363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant