Colleen Booth, PA-C
Physician Assistant in Manchester, CT. Individual provider (NPI-1).
NPI number1972022135
StatusActive
Last updated in NPPESOct 17, 2018
Details
- NPI
- 1972022135
- Entity type
- Individual (NPI-1)
- Name
- Colleen Booth
- Credential
- PA-C
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Sep 19, 2017
- Last updated
- Oct 17, 2018
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - PHYSICIAN ASSISTANT
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 3964 | CT | Yes |
| 363AM0700X | Physician Assistant, Medical | 3964 | CT |
Practice location
71 Haynes StManchester, CT 06040-4131
Phone 860-646-1222
Mailing address
104 Pitkin StManchester, CT 06040-4456
Phone 860-685-0816
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 47 Physician Assistant providers in Manchester · All 2,597 providers in Manchester
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