Provider Demographics
NPI:1932351673
Name:ASCENZIA, MICHAEL ANTHONY (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:ASCENZIA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 QUARRY FARMS
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06451-2085
Mailing Address - Country:US
Mailing Address - Phone:203-440-1496
Mailing Address - Fax:
Practice Address - Street 1:360 TOLLAND TPKE STE 1A
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-1759
Practice Address - Country:US
Practice Address - Phone:860-553-6551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002060363AM0700X, 363AS0400X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT06-1406459OtherCOMMUNITY HEALTH NETWORK
CT06-1406459OtherGREAT WEST HEALTHCARE
CT06-1406459OtherPRIVATE HEALTHCARE SYSTEMS
CT06-1406459OtherNORTHEAST HEALTH DIRECT
CT06-1406459OtherMULTIPLAN
CT3V1079OtherHEALTH NET
CT06-1406459OtherPIONEER
CT290002060CT01OtherANTHEM BCBS OF CT
CT206000OtherCONNECTICARE
CT06-1406459OtherTRICARE
CT3V1079OtherHEALTH NET