Provider Demographics
NPI:1922170679
Name:LEDERMAN, LAURENCE NEAL (MD)
Entity Type:Individual
Prefix:
First Name:LAURENCE
Middle Name:NEAL
Last Name:LEDERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 EAST MAIN ST
Mailing Address - Street 2:STE B-11
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-5652
Mailing Address - Country:US
Mailing Address - Phone:203-237-5232
Mailing Address - Fax:203-237-9328
Practice Address - Street 1:95 EAST MAIN ST
Practice Address - Street 2:STE B-11
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-5652
Practice Address - Country:US
Practice Address - Phone:203-237-5232
Practice Address - Fax:203-237-9328
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT157942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B83343Medicare UPIN
260000448Medicare ID - Type Unspecified