Provider Demographics
NPI:1801878681
Name:LAO, ERIC T (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:T
Last Name:LAO
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 1:216 HEMLOCK AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-9607
Mailing Address - Country:US
Mailing Address - Phone:860-697-6565
Mailing Address - Fax:
Practice Address - Street 1:216 HEMLOCK AVE STE 104
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-9607
Practice Address - Country:US
Practice Address - Phone:860-697-6565
Practice Address - Fax:860-730-4661
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209983207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine