Individual
DAVID C LY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
267 GRANT ST, BRIDGEPORT, CT 06610
(203) 284-3000
Mailing address
16 ALLEN PL, NEW HAVEN, CT 06512-1805
(714) 623-5917
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
020734
NY
363A00000X
Physician Assistant
PA61060288
WA
363AM0700X
Medical Physician Assistant
Primary
2793
CT
Other
Enumeration date
09/18/2012
Last updated
06/16/2021
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