Provider Demographics
NPI:1780683235
Name:LOTTICK, ADAM T (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:T
Last Name:LOTTICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:112 QUARRY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4816
Mailing Address - Country:US
Mailing Address - Phone:203-333-8800
Mailing Address - Fax:203-333-6054
Practice Address - Street 1:112 QUARRY RD
Practice Address - Street 2:SUITE 400
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4816
Practice Address - Country:US
Practice Address - Phone:203-333-8800
Practice Address - Fax:203-333-6054
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT40759207RC0001X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400133273Medicare PIN
CTG45286Medicare UPIN
CTG45286Medicare UPIN