Provider Demographics
NPI:1255310033
Name:LEFEBVRE, SUZANNE (MD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:LEFEBVRE
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 1:64 MAPLE ST
Mailing Address - Street 2:BOX 885
Mailing Address - City:KENT
Mailing Address - State:CT
Mailing Address - Zip Code:06757-1721
Mailing Address - Country:US
Mailing Address - Phone:860-927-1133
Mailing Address - Fax:860-927-1166
Practice Address - Street 1:64 MAPLE ST
Practice Address - Street 2:BOX 885
Practice Address - City:KENT
Practice Address - State:CT
Practice Address - Zip Code:06757-1721
Practice Address - Country:US
Practice Address - Phone:860-927-1133
Practice Address - Fax:860-927-1166
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT041413207R00000X, 208000000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001414135Medicaid
CT001414135Medicaid
CT110008908Medicare ID - Type Unspecified