Provider Demographics
NPI:1831344902
Name:O'CONNOR, PEGGY RUBIO (PA)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:RUBIO
Last Name:O'CONNOR
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 1:20 YORK ST
Mailing Address - Street 2:WINCHESTER CHEST CLINIC
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3220
Mailing Address - Country:US
Mailing Address - Phone:203-785-4198
Mailing Address - Fax:203-737-5453
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:WINCHESTER CHEST CLINIC
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-785-4198
Practice Address - Fax:203-737-5453
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002194363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant