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Individual
PATRICK J CREEDON
Active
Individual
PATRICK J CREEDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
001265
CT
363AS0400X
Surgical Physician Assistant
Primary
001265
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003012655
—
CT
Enumeration date
09/25/2006
Last updated
04/12/2017
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