Provider Demographics
NPI:1497802417
Name:LACERTE, LINDA LEA (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LEA
Last Name:LACERTE
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 1:112 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2737
Mailing Address - Country:US
Mailing Address - Phone:860-889-8331
Mailing Address - Fax:
Practice Address - Street 1:80 NORWICH NEW LONDON TPKE
Practice Address - Street 2:
Practice Address - City:UNCASVILLE
Practice Address - State:CT
Practice Address - Zip Code:06382-2527
Practice Address - Country:US
Practice Address - Phone:860-848-1297
Practice Address - Fax:860-848-9875
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036334207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001363340Medicaid
CTD400063897Medicare PIN