Provider Demographics
NPI:1508950247
Name:SEYBOLT, LORNA M (MD)
Entity type:Individual
Prefix:DR
First Name:LORNA
Middle Name:M
Last Name:SEYBOLT
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 1:2200 WHITNEY AVE STE 290
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3695
Mailing Address - Country:US
Mailing Address - Phone:203-903-8308
Mailing Address - Fax:203-599-3927
Practice Address - Street 1:2200 WHITNEY AVE STE 290
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3695
Practice Address - Country:US
Practice Address - Phone:203-903-8308
Practice Address - Fax:203-599-3927
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT770942080P0208X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2171070Medicaid
LA332740YH58OtherMEDICARE
MEH46192Medicare UPIN
MEME155802Medicare PIN
ME431809399Medicaid
NH30205141Medicaid
MEME155801Medicare PIN