Provider Demographics
NPI:1154509347
Name:ROBERT G. LUSSIER, M.D., LLC
Entity Type:Organization
Organization Name:ROBERT G. LUSSIER, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:LUSSIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-652-0472
Mailing Address - Street 1:36 WELLES ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2080
Mailing Address - Country:US
Mailing Address - Phone:860-652-0472
Mailing Address - Fax:860-652-3431
Practice Address - Street 1:36 WELLES ST
Practice Address - Street 2:SUITE 230
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2080
Practice Address - Country:US
Practice Address - Phone:860-652-0472
Practice Address - Fax:860-652-3431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-10
Last Update Date:2008-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0261232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03503OtherMEICARE GROUP NUMBER