Provider Demographics
NPI:1235110354
Name:LUSKIND, ROGER D (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:D
Last Name:LUSKIND
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:400 SAYBROOK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4773
Mailing Address - Country:US
Mailing Address - Phone:860-347-7466
Mailing Address - Fax:860-347-2619
Practice Address - Street 1:400 SAYBROOK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4773
Practice Address - Country:US
Practice Address - Phone:860-347-7466
Practice Address - Fax:860-347-2619
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2007-07-10
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Provider Licenses
StateLicense IDTaxonomies
CT29136207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD21203Medicare UPIN