Provider Demographics
NPI:1679893572
Name:SOSA-BERGERON, LYNN E (MD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:E
Last Name:SOSA-BERGERON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:E
Other - Last Name:SOSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:410 CAPITOL AVENUE MS #11 TUB
Mailing Address - Street 2:PO BOX 340308
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06134-0308
Mailing Address - Country:US
Mailing Address - Phone:860-509-7723
Mailing Address - Fax:
Practice Address - Street 1:131 COVENTRY ST
Practice Address - Street 2:HARTFORD HEALTH DEPARTMENT
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112-1548
Practice Address - Country:US
Practice Address - Phone:860-757-4830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043692207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine