Provider Demographics
NPI:1225407141
Name:GIRARD, ALEXI A (PA-C)
Entity type:Individual
Prefix:
First Name:ALEXI
Middle Name:A
Last Name:GIRARD
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:ALEXI
Other - Middle Name:A
Other - Last Name:TETRAULT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:330 WESTERN BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4383
Mailing Address - Country:US
Mailing Address - Phone:860-547-0306
Mailing Address - Fax:
Practice Address - Street 1:330 WESTERN BLVD STE 102
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4383
Practice Address - Country:US
Practice Address - Phone:860-547-0306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-21
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDI100000733133V00000X
363AS0400X, 390200000X
CT5068363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program