Provider Demographics
NPI:1518191667
Name:PUGLISI, LISA (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:PUGLISI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:333 CEDAR ST
Mailing Address - Street 2:P.O. BOX 208030
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520
Mailing Address - Country:US
Mailing Address - Phone:203-688-5555
Mailing Address - Fax:203-688-4516
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:YALE-NEW HAVEN HOSPITAL
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510
Practice Address - Country:US
Practice Address - Phone:203-688-5555
Practice Address - Fax:203-688-4516
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
CT050755207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004217099Medicaid
CT008041410Medicaid
CT008068298Medicaid
CT008056033Medicaid
CT008056168Medicaid