Provider Demographics
NPI:1922200559
Name:PATRICIA LAMPUGNALE, D.O., LLC
Entity Type:Organization
Organization Name:PATRICIA LAMPUGNALE, D.O., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMPUGNALE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:860-659-0629
Mailing Address - Street 1:31 SYCAMORE ST
Mailing Address - Street 2:SUITE 201-B
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4540
Mailing Address - Country:US
Mailing Address - Phone:860-659-0629
Mailing Address - Fax:860-714-6698
Practice Address - Street 1:31 SYCAMORE ST
Practice Address - Street 2:SUITE 201-B
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4540
Practice Address - Country:US
Practice Address - Phone:860-659-0629
Practice Address - Fax:860-714-6698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000397207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT04214342Medicaid
CT04214342Medicaid
CH8992Medicare PIN