Individual
KATELYN MASTROGIACOMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2800 MAIN ST, BRIDGEPORT, CT 06606-4201
(203) 576-6000
Mailing address
635 ASHLEY CT, CHESHIRE, CT 06410-3246
(203) 980-1836
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
4397
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/29/2018
Last updated
04/01/2024
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