Provider Demographics
NPI:1780604017
Name:PELLETIER, BARBARA KURAITIS (PA)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:KURAITIS
Last Name:PELLETIER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2699
Mailing Address - Street 2:DEPT. 200
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06146-2699
Mailing Address - Country:US
Mailing Address - Phone:866-898-7138
Mailing Address - Fax:616-975-9824
Practice Address - Street 1:56 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06706-1253
Practice Address - Country:US
Practice Address - Phone:203-709-6004
Practice Address - Fax:203-709-3700
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000465363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400009238OtherMEDICARE PTAN FOR JOHN DEMPSEY HOSPITAL
CTD400009238OtherMEDICARE PTAN FOR JOHN DEMPSEY HOSPITAL
CT970002302Medicare PIN