Provider Demographics
NPI:1508860156
Name:RADIN, LAURENCE I (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:I
Last Name:RADIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:350 MONTAUK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-4730
Mailing Address - Country:US
Mailing Address - Phone:860-443-1891
Mailing Address - Fax:860-443-2980
Practice Address - Street 1:350 MONTAUK AVE
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4730
Practice Address - Country:US
Practice Address - Phone:860-443-1891
Practice Address - Fax:860-443-2980
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT0320512084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1320514Medicaid
CT1320514Medicaid