Provider Demographics
NPI:1174795371
Name:BRENES, LAURA CELESTE (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:CELESTE
Last Name:BRENES
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 1:76 BATTERSON PARK RD STE 106
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2571
Mailing Address - Country:US
Mailing Address - Phone:203-228-2097
Mailing Address - Fax:203-816-5564
Practice Address - Street 1:76 BATTERSON PARK RD STE 106
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2571
Practice Address - Country:US
Practice Address - Phone:203-228-2097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT046967207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1174795371Medicaid
CTP00964331OtherRAILROAD MEDICARE
CT9473362OtherAETNA
CT608892OtherWELLCARE
CT1174795371Medicaid