Provider Demographics
NPI:1750797973
Name:PALOMBA, ELIZABETH ASHLEY (PA-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ASHLEY
Last Name:PALOMBA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ASHLEY
Other - Last Name:DOYKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:114 WOODLAND ST
Mailing Address - Street 2:NICU
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1208
Mailing Address - Country:US
Mailing Address - Phone:860-714-4404
Mailing Address - Fax:860-714-4595
Practice Address - Street 1:114 WOODLAND ST
Practice Address - Street 2:NICU
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1208
Practice Address - Country:US
Practice Address - Phone:860-714-4404
Practice Address - Fax:860-714-4595
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA6169363A00000X
CT3110363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant