Provider Demographics
NPI:1952613218
Name:CHASE, LAUREN KOPYT (MD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:KOPYT
Last Name:CHASE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:BETH
Other - Last Name:KOPYT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:785 FARMINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119
Mailing Address - Country:US
Mailing Address - Phone:860-523-4100
Mailing Address - Fax:860-523-1462
Practice Address - Street 1:785 FARMINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119
Practice Address - Country:US
Practice Address - Phone:860-523-4100
Practice Address - Fax:860-523-1462
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-02
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08786200208000000X
CT049286208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008030211Medicaid