Individual
ERIK BAISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
267 GRANT ST, BRIDGEPORT, CT 06610-2870
(203) 384-3566
Mailing address
132 RACE HILL RD, GUILFORD, CT 06437-1011
(570) 768-8142
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4350
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4350
CONNECTICUT PHYSICIAN ASSISTANT LICENSE
CT
01
—
69937
CONNECTICUT CONTROLLED SUBSTANCE REGISTRATION
CT
Enumeration date
12/06/2018
Last updated
12/06/2018
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