Individual
DIMITRI GHECAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
11 OLD PARK LANE, NEW MILFORD, CT 06776
(860) 355-1149
(860) 355-5957
Mailing address
11 OLD PARK LANE, NEW MILFORD, CT 06776
(860) 355-1149
(860) 355-5957
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
022592
NY
363AM0700X
Medical Physician Assistant
00735
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00735
CT LICENSE
CT
01
—
290000735CT01
ANTHEM BC/BS
CT
01
—
2V3651
ACS/HEALTHNET
CT
01
—
713282
CONNECTICARE
CT
01
—
P00006823
RAILROAD MEDICARE
CT
01
—
P2737999
OXFORD
CT
Enumeration date
02/02/2006
Last updated
06/18/2024
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