Provider Demographics
NPI:1144207655
Name:SCHUCK, ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:SCHUCK
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 1:1060 DAY HILL RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-5719
Mailing Address - Country:US
Mailing Address - Phone:860-683-2690
Mailing Address - Fax:860-683-2670
Practice Address - Street 1:1060 DAY HILL RD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-5719
Practice Address - Country:US
Practice Address - Phone:860-683-2690
Practice Address - Fax:860-683-2670
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT41101207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001411016Medicaid
CT1144207655OtherNPI
P00023955Medicare PIN
CT1144207655OtherNPI
H88681Medicare UPIN