Provider Demographics
NPI:1427466150
Name:SALVADOR, KATHERINE (PA-C)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:
Last Name:SALVADOR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:32 FAIRFAX AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-2003
Mailing Address - Country:US
Mailing Address - Phone:617-750-4808
Mailing Address - Fax:
Practice Address - Street 1:33 PRATT ST
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1014
Practice Address - Country:US
Practice Address - Phone:860-946-0447
Practice Address - Fax:860-430-6861
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA5048363AM0700X
CT3995363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPA5048OtherLICENSE
CT3995OtherLICENSE