Provider Demographics
NPI:1265430219
Name:MORGAN, LANCELOT P (PA)
Entity type:Individual
Prefix:
First Name:LANCELOT
Middle Name:P
Last Name:MORGAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:99 E RIVER DR
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-3288
Mailing Address - Country:US
Mailing Address - Phone:860-282-4022
Mailing Address - Fax:860-289-0742
Practice Address - Street 1:360 TOLLAND TPKE
Practice Address - Street 2:3C
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-1771
Practice Address - Country:US
Practice Address - Phone:860-643-0063
Practice Address - Fax:860-643-3642
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2012-05-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT001620363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTQ45776Medicare UPIN
CT970001883Medicare ID - Type UnspecifiedPROVIDER NUMBER