Provider Demographics
NPI:1326406224
Name:GEPIGON, GEROME MEDINACELI (PA-C)
Entity type:Individual
Prefix:
First Name:GEROME
Middle Name:MEDINACELI
Last Name:GEPIGON
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1290 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4337
Mailing Address - Country:US
Mailing Address - Phone:860-972-9033
Mailing Address - Fax:860-972-7040
Practice Address - Street 1:399 FARMINGTON AVE STE 210
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1944
Practice Address - Country:US
Practice Address - Phone:860-548-7338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-05
Last Update Date:2024-09-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT6763363AS0400X
NH1145363AS0400X
WA61032719363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical