PROF. LEAH GYNELL WALLACE (NPI# 1518233931) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518233931 |
| Entity Type | Individual |
| Full Name | PROF. LEAH GYNELL WALLACE |
| Credential | PA-C |
| Practice Address |
1347 Boston Post Rd Suite 106 Madison CT 06443-3475 |
| Mailing Address |
28 Crescent St Suite 106 Middletown CT 06457-3654 |
| Practice Telephone | 2037795207 |
| Practice Fax Number | 2037795792 |
| Mailing Telephone | 8603584820 |
| Mailing Fax Number | 8603588661 |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2015-02-25 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 002731 | CT | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | 008039969 | 05 |
| Street Address |
1347 BOSTON POST RD SUITE 106 |
| City | MADISON |
| State | CT |
| Zip Code | 06443-3475 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144235847 | Madison Eye Care LLC | Optometrist | 1347 Boston Post Rd, #101, Madison, CT 06443-3475 | 2006-07-30 |
| 1366799587 | Jessica L Paulson | Physician Assistant | 1347 Boston Post Rd, Madison, CT 06443-3475 | 2012-08-07 |
| 1316164858 | Sarah Orlando | Physician Assistant | 1347 Boston Post Rd, Madison, CT 06443-3475 | 2007-04-19 |
| 1588710545 | Edward L Berlin | Dentist | 1347 Boston Post Rd, Madison, CT 06443-3475 | 2007-01-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194127506 | Heather R. Clinton | Social Worker | 847 West Main Street, Suite 3, Branford, CT 06443 | 2014-09-17 |
| 1477973378 | Katrina Louise Furey | Psychiatry & Neurology | 147 Durham Rd Ste 12a-ne, Madison, CT 06443 | 2014-04-18 |
| 1972920114 | Elizabeth Laberee | Internal Medicine | 80 Devonshire Lane, Madison, CT 06443 | 2014-03-26 |
| 1588007314 | Avery Grauer | Psychiatry & Neurology | 175 Copse Road, Madison, CT 06443 | 2013-04-11 |
| 1295077790 | Gordon Seth Cohen | Pathology | 3 Silo Hill Road, Madison, CT 06443 | 2013-03-22 |
| 1073750493 | Darlene F. Talavera | Occupational Therapist | 22 Overshore Drive, Madison, CT 06443 | 2009-01-08 |
| 1013182518 | Susan Jean Isaac | Social Worker | 105 Winding Road, Unit 2, Madison, CT 06443 | 2008-04-25 |
| 1083893606 | Kornelia Keszler, Md, PC | Internal Medicine | 1-b Meigswood Ave, Madison, CT 06443 | 2007-10-31 |
| 1811181126 | Traci Marando | Nurse Practitioner | 20 Madrina Lane, Madison, CT 06443 | 2007-08-29 |
| 1790803419 | Linda L. Young | Social Worker | 2 Samson Rock Drive, Unit 2g, Madison, CT 06443 | 2007-03-27 |
| Find all providers in zip 06443 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710594403 | Mary Josephine Elliott | Physician Assistant | 50 Beechwood Dr, Madison, CT 06443-1847 | 2020-09-26 |
| 1194354928 | Shqipe Ademi | Physician Assistant | 5417 Hazelcrest Dr, Madison, WI 53704-8910 | 2020-04-03 |
| 1902432685 | Therese Rowe | Physician Assistant | 1 Point Pl Ste 200, Madison, WI 53719-2836 | 2020-03-13 |
| 1437784139 | Mark Mckinney | Physician Assistant | 750 Highland Ave # Hslc1270, Madison, WI 53705-2221 | 2020-03-03 |
| 1619511706 | Nicole Frakes | Physician Assistant | 750 Highland Ave, Madison, WI 53705-2221 | 2019-10-31 |
| 1508428558 | Martha Busse | Physician Assistant | 1650 Monroe St Apt D, Madison, WI 53711-2045 | 2019-06-30 |
| 1669942249 | Patrick Soltvedt Bohn | Physician Assistant | 1034 Waban Hill, Madison, WI 53711 | 2018-11-27 |
| 1487124020 | Kaitlyn Jolena Mcmackin | Physician Assistant | 120 Fountains Blvd Ste 1000, Madison, MS 39110-6343 | 2018-11-27 |
| 1013493907 | Paulina A Hall | Physician Assistant | 700 S Park St Suite A, Madison, WI 53715-5228 | 2018-07-13 |
| 1700370020 | Mark Diaz IIi | Physician Assistant | 77 S Oakbridge Ct Apt 105, Madison, WI 53717-2030 | 2018-06-20 |
| Find all providers in MADISON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.