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EAST HADDAM MEDICAL ASSOCIATE,PC
NPI 1063472363
Physician Assistant in Moodus, CT

Active since March 23, 2006
16 WILLIAM F PALMER RD, MOODUS, CT 06469(860) 873-1414(860) 873-3428 Get Directions Write a Review

NPPES record last updated: September 11, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Sep 11, 2025, Aug 22, 2020 (2 updates tracked since 2020).

About East Haddam Medical Associate,pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EAST HADDAM MEDICAL ASSOCIATE,PC (NPI 1063472363) is a healthcare organization registered as a physician assistant in Moodus, Connecticut and active in the NPI registry since March 2006. The organization lists Pamela Gourlie, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1063472363
Entity TypeOrganization
Primary Taxonomy363A00000X
Legal Business NameEAST HADDAM MEDICAL ASSOCIATE,PC
Location Address16 WILLIAM F PALMER RDMoodus, CT 06469-1131
Mailing Address16 William F Palmer Rd, P O Box 430Moodus, CT 06469-1131 · (860) 873-1414 · Fax (860) 873-3428
Phone(860) 873-1414
Fax(860) 873-3428
Organization SubpartNo
Authorized OfficialPamela GourlieOffice Manager · (860) 873-8983
Enumeration DateMarch 23, 2006
Last NPPES UpdateSeptember 11, 20252 updates tracked since enumeration
✔ NPI 1063472363 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in CT · 000457
Definition
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.
Also ListedFamily MedicineTaxonomy 207Q00000X · License 024845 (CT)
16 WILLIAM F PALMER RD, Moodus, CT 06469
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is East Haddam Medical Associate,pc's NPI number?

The NPI number for East Haddam Medical Associate,pc is 1063472363. It was assigned to this organization in the NPPES registry on March 23, 2006.

Where is East Haddam Medical Associate,pc located?

East Haddam Medical Associate,pc is located at 16 William F Palmer Rd, Moodus, CT 06469. The listed phone number is (860) 873-1414.

What is East Haddam Medical Associate,pc's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

When was this NPI record last updated?

The NPPES record for East Haddam Medical Associate,pc was last updated on September 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.