Provider Demographics
NPI:1841475126
Name:BALL, GENIE NOELLE (PA-C)
Entity type:Individual
Prefix:MS
First Name:GENIE
Middle Name:NOELLE
Last Name:BALL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:GENIE
Other - Middle Name:NOELLE
Other - Last Name:KOUTROUPAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:32 STRAWBERRY HILL CT
Mailing Address - Street 2:SUITE 11001
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2594
Mailing Address - Country:US
Mailing Address - Phone:203-276-4400
Mailing Address - Fax:203-276-4401
Practice Address - Street 1:32 STRAWBERRY HILL CT
Practice Address - Street 2:SUITE 11001
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2594
Practice Address - Country:US
Practice Address - Phone:203-276-4400
Practice Address - Fax:203-276-4401
Is Sole Proprietor?:No
Enumeration Date:2008-01-04
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2003363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003020039Medicaid