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LARISSA MAGNESS FOPEANO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
1291 BOSTON POST RD STE 105, MADISON, CT 06443-3476
(860) 358-5100
(860) 358-8655
Mailing address
28 CRESCENT ST, MIDDLETOWN, CT 06457-3654
(860) 358-6000

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
003036
CT
363A00000X
Physician Assistant
Primary
015899
NY

Other

Enumeration date
08/27/2012
Last updated
01/29/2024
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