Provider Demographics
NPI:1649218223
Name:DONOFRIO, LISA MARIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIAN
Last Name:DONOFRIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:4 SAINT RONAN TER
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-2315
Mailing Address - Country:US
Mailing Address - Phone:203-865-6143
Mailing Address - Fax:
Practice Address - Street 1:134 PARK ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5409
Practice Address - Country:US
Practice Address - Phone:203-865-6143
Practice Address - Fax:203-772-1265
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT035052207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTF05290Medicare UPIN