Provider Demographics
NPI:1902894801
Name:LATRONICA, KATHLEEN (PA)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:LATRONICA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3209
Mailing Address - Country:US
Mailing Address - Phone:203-407-3500
Mailing Address - Fax:203-281-1164
Practice Address - Street 1:2408 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3209
Practice Address - Country:US
Practice Address - Phone:203-407-3500
Practice Address - Fax:203-281-1164
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
CT000709363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT970001104Medicare PIN
CTP68004Medicare UPIN