Provider Demographics
NPI:1205851169
Name:LEBOWITZ, ARTHUR L (MD)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:L
Last Name:LEBOWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CHASE PKWY
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3346
Mailing Address - Country:US
Mailing Address - Phone:203-574-5504
Mailing Address - Fax:203-574-1275
Practice Address - Street 1:130 S MAIN ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:CT
Practice Address - Zip Code:06787-1741
Practice Address - Country:US
Practice Address - Phone:860-283-0286
Practice Address - Fax:203-575-5119
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037737207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010037737CT01OtherANTHEM
CT001377375Medicaid
CT110170615OtherRAILROAD MEDICARE
CTG03960Medicare UPIN
CT110007549Medicare ID - Type Unspecified