Provider Demographics
NPI:1548271463
Name:SPOSATO, MICHAEL ANTHONY (PA-C)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:SPOSATO
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:98 MAIN ST STE 301
Mailing Address - Street 2:MIDSTATE MEDICAL GROUP
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-2500
Mailing Address - Country:US
Mailing Address - Phone:860-621-6704
Mailing Address - Fax:860-620-0446
Practice Address - Street 1:98 MAIN ST
Practice Address - Street 2:MIDSTATE MEDICAL GROUP
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-2500
Practice Address - Country:US
Practice Address - Phone:860-621-6704
Practice Address - Fax:860-620-0446
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2012-05-16
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Provider Licenses
StateLicense IDTaxonomies
CT000066363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTS93602Medicare UPIN