Provider Demographics
NPI:1487684288
Name:LEDERMAN, HARVEY D (DPM)
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:D
Last Name:LEDERMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:MARC
Other - Middle Name:A
Other - Last Name:LEDERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:2531 ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-2308
Mailing Address - Country:US
Mailing Address - Phone:860-236-2564
Mailing Address - Fax:860-233-0251
Practice Address - Street 1:2531 ALBANY AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-2308
Practice Address - Country:US
Practice Address - Phone:860-236-2564
Practice Address - Fax:860-233-0251
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT107213ES0131X
CT429213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTT23477Medicare UPIN
CT480000089Medicare PIN