Provider Demographics
NPI:1235173873
Name:KUGELMAN, LISA C (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:C
Last Name:KUGELMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:65 MEMORIAL RD
Mailing Address - Street 2:SUITE 450
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2434
Mailing Address - Country:US
Mailing Address - Phone:860-523-1087
Mailing Address - Fax:860-523-1472
Practice Address - Street 1:65 MEMORIAL RD
Practice Address - Street 2:SUITE 450
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2434
Practice Address - Country:US
Practice Address - Phone:860-523-1087
Practice Address - Fax:860-523-1472
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT031336207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTE75491Medicare UPIN