Provider Demographics
NPI:1083892483
Name:OLIVER, LORI-ANN CAMILLE (MD)
Entity Type:Individual
Prefix:
First Name:LORI-ANN
Middle Name:CAMILLE
Last Name:OLIVER
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 1:333 CEDAR ST # STREET3
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3206
Mailing Address - Country:US
Mailing Address - Phone:203-737-1549
Mailing Address - Fax:203-785-6664
Practice Address - Street 1:333 CEDAR ST # STREET3
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3206
Practice Address - Country:US
Practice Address - Phone:203-737-1549
Practice Address - Fax:203-785-6664
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2012-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247062207R00000X
CT051207207L00000X
PAMD442481207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine