Provider Demographics
NPI:1811907686
Name:LOCKHART, ROBERTA (MD)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:LOCKHART
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 1:50 COMMERCE PARK
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3565
Mailing Address - Country:US
Mailing Address - Phone:203-882-2066
Mailing Address - Fax:203-882-2074
Practice Address - Street 1:50 COMMERCE PARK
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3565
Practice Address - Country:US
Practice Address - Phone:203-882-2066
Practice Address - Fax:203-882-2074
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031961208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1319616Medicaid