Provider Demographics
NPI:1316341829
Name:NOTARINO, CHRISTINA NOEL (PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:NOEL
Last Name:NOTARINO
Suffix:
Gender:F
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 1:64 GLENMOOR DR
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-1212
Mailing Address - Country:US
Mailing Address - Phone:203-645-0531
Mailing Address - Fax:
Practice Address - Street 1:299 WASHINGTON AVE STE LL
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3039
Practice Address - Country:US
Practice Address - Phone:203-288-4288
Practice Address - Fax:855-414-4010
Is Sole Proprietor?:No
Enumeration Date:2014-10-13
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003205363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008056585Medicaid