Provider Demographics
NPI:1093710972
Name:LEBLANC, LYNN (DPM)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 NORTHWESTERN DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3400
Mailing Address - Country:US
Mailing Address - Phone:860-243-2951
Mailing Address - Fax:860-243-5790
Practice Address - Street 1:1 NORTHWESTERN DR
Practice Address - Street 2:SUITE 301
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3400
Practice Address - Country:US
Practice Address - Phone:860-243-2951
Practice Address - Fax:860-243-5790
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000530213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1093710972OtherNPI
CT030000530CT04OtherFEDERAL BLUE CROSS ID
CTPL0161OtherMEDIBLUE PROVIDER ID
CT3204678OtherAETNA PROVIDER ID
CT748411OtherCONNECTICARE PROVIDER ID
CT1162763OtherUNITED HEALTH PROVIDER ID
CT030000530CT04OtherANTHEM PROVIDER ID
CT1396931648OtherNPI
CT298258OtherWELLCARE PROVIDER ID
CT2V4184OtherHEALTH NET PROVIDER ID
CTHAS386OtherOXFORD PROVIDER ID
CT004235645Medicaid
CT0170716OtherCIGNA PROVIDER ID
CT1235281288OtherGROUP NPI
CT480000912OtherMEDICARE PROVIDER ID
CTHAS386OtherOXFORD PROVIDER ID
CT004235645Medicaid