Provider Demographics
NPI:1073549978
Name:GREENWALD, LORI L (MD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:L
Last Name:GREENWALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BARNARD LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2413
Mailing Address - Country:US
Mailing Address - Phone:860-761-6666
Mailing Address - Fax:860-761-2502
Practice Address - Street 1:1 BARNARD LN
Practice Address - Street 2:SUITE 201
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2413
Practice Address - Country:US
Practice Address - Phone:860-761-6666
Practice Address - Fax:860-761-2502
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT030092174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2V3352OtherHEALTHNET
CT010030092CT01OtherANTHEM BLUE CROSS BLUE SH
CT0331765004OtherCIGNA HEALTHCARE
CTHAS612OtherOXFORD
CT001300920-03OtherBLUECARE FAMILY PLAN
CT3224455OtherAETNA
CT707767OtherCONNECTICARE
CT0331765004OtherCIGNA HEALTHCARE
CT001300920-03OtherBLUECARE FAMILY PLAN