Individual
CORY R. DEGIACOMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
71 HAYNES ST, MANCHESTER, CT 06040-4131
(860) 646-1222
Mailing address
71 HAYNES ST, MANCHESTER, CT 06040-4131
(860) 646-1222
(860) 688-6403
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
001079
CT
363A00000X
Physician Assistant
Primary
4461
CT
363AM0700X
Medical Physician Assistant
Primary
4461
CT
Other
Enumeration date
11/04/2016
Last updated
04/22/2026
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