Provider Demographics
NPI:1932351673
Name:ASCENZIA, MICHAEL ANTHONY (PA-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:ASCENZIA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CELLINI PL STE 102
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-1666
Mailing Address - Country:US
Mailing Address - Phone:203-932-6481
Mailing Address - Fax:203-932-4051
Practice Address - Street 1:1 CELLINI PL STE 102
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-1666
Practice Address - Country:US
Practice Address - Phone:203-932-6481
Practice Address - Fax:203-932-4051
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
CT002060363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT06-1406459OtherTRICARE
CT3V1079OtherHEALTH NET
CT06-1406459OtherNORTHEAST HEALTH DIRECT
CT206000OtherCONNECTICARE
CT06-1406459OtherMULTIPLAN
CT06-1406459OtherPIONEER
CT06-1406459OtherPRIVATE HEALTHCARE SYSTEMS
CT06-1406459OtherGREAT WEST HEALTHCARE
CT06-1406459OtherCOMMUNITY HEALTH NETWORK
CT290002060CT01OtherANTHEM BCBS OF CT
CT3V1079OtherHEALTH NET