Individual
KATHY E DELUCIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
305 BLACK ROCK TPKE, FAIRFIELD, CT 06825-5508
(203) 337-2600
(203) 337-2666
Mailing address
305 BLACK ROCK TPKE, OSG, FAIRFIELD, CT 06825-5508
(203) 337-2600
(203) 337-2666
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
000130
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
290000130CT01
ANTHEM BC/BS
CT
01
—
2V6005
HEALTH NET
CT
01
—
9301
CONNECTICARE
CT
01
—
P3511340
OXFORD HEALTH PLANS
CT
01
—
TIN
CORVEL
—
Enumeration date
07/25/2006
Last updated
03/30/2017
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