Provider Demographics
NPI:1801047337
Name:CHARRON, KATE (PA)
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:CHARRON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:BIESADECKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2200 WHITNEY AVE
Mailing Address - Street 2:SUITE 360
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3691
Mailing Address - Country:US
Mailing Address - Phone:203-281-4463
Mailing Address - Fax:203-287-2930
Practice Address - Street 1:2200 WHITNEY AVE
Practice Address - Street 2:SUITE 360
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3691
Practice Address - Country:US
Practice Address - Phone:203-281-4463
Practice Address - Fax:203-287-2930
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002180363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400000552Medicare PIN