Individual
MR. JUSTIN CHAMPAGNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
134 GRANDVIEW AVE, WATERBURY, CT 06708-2507
(203) 756-8911
(203) 574-0548
Mailing address
134 GRANDVIEW AVE, WATERBURY, CT 06708-2507
(203) 756-8911
(203) 574-0548
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
001721
CT
363AM0700X
Medical Physician Assistant
Primary
001721
CT
Other
Enumeration date
10/25/2006
Last updated
01/12/2012
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