Provider Demographics
NPI:1831387596
Name:GENDRON, TAMMY M (PA-C)
Entity type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:M
Last Name:GENDRON
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:31 SEYMOUR ST STE 204A
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5521
Mailing Address - Country:US
Mailing Address - Phone:860-972-0475
Mailing Address - Fax:
Practice Address - Street 1:31 SEYMOUR ST STE 204
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5521
Practice Address - Country:US
Practice Address - Phone:860-972-0475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2023-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002081363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical