Basic Information
| Provider Information | |||||||||
| NPI: | 1184855017 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DALL | ||||||||
| FirstName: | CHRIS | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2408 WHITNEY AVE | ||||||||
| Address2: | |||||||||
| City: | HAMDEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065183209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036260160 | ||||||||
| FaxNumber: | 2032946734 | ||||||||
| Practice Location | |||||||||
| Address1: | 2408 WHITNEY AVE | ||||||||
| Address2: | |||||||||
| City: | HAMDEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065183209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034073500 | ||||||||
| FaxNumber: | 2034074244 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2009 | ||||||||
| LastUpdateDate: | 03/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 2288 | CT | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AS0400X | 002288 | CT | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363AS0400X | 2288 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.