Individual
MR. KEVIN MICHAEL CHANDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
64 ROBBINS ST, WATERBURY, CT 06708-2613
(203) 573-6000
Mailing address
48 WALNUT ST, THOMASTON, CT 06787-1540
(917) 971-8350
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
002550
CT
363A00000X
Physician Assistant
011879
NY
363AM0700X
Medical Physician Assistant
Primary
002550
CT
Other
Enumeration date
06/28/2007
Last updated
12/24/2018
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