Provider Demographics
NPI:1962847780
Name:WHITMIRE, LACEY (MD)
Entity Type:Individual
Prefix:DR
First Name:LACEY
Middle Name:
Last Name:WHITMIRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:15 YORK ST
Mailing Address - Street 2:LMP 1091B
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3221
Mailing Address - Country:US
Mailing Address - Phone:203-785-7941
Mailing Address - Fax:203-785-3922
Practice Address - Street 1:789 HOWARD AVE
Practice Address - Street 2:ADULT PRIMARY CARE CENTER
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1304
Practice Address - Country:US
Practice Address - Phone:203-688-2984
Practice Address - Fax:203-688-4092
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2017-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT56178207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine