Provider Demographics
NPI:1861476632
Name:SEMERARO, LUCILLE A (MD)
Entity Type:Individual
Prefix:
First Name:LUCILLE
Middle Name:A
Last Name:SEMERARO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 SARGENT DR
Mailing Address - Street 2:STE 6
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-6110
Mailing Address - Country:US
Mailing Address - Phone:203-781-4321
Mailing Address - Fax:203-781-4329
Practice Address - Street 1:150 SARGENT DR
Practice Address - Street 2:STE 6
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-6110
Practice Address - Country:US
Practice Address - Phone:203-781-4321
Practice Address - Fax:203-781-4329
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT023296208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00123966Medicaid
CT00123966Medicaid
CTD400012900Medicare PIN