MEDICARE: DR. LISA GALE SUTER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	040852	CT

General Provider Information

NPI Number	:	1447281035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA GALE SUTER M.D.

Provider Business Mailing Address
First Line	:	16 MILL RD
Second Line	:
City	:	NORTH BRANFORD
State	:	CT
Zip	:	06471-1060
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 CEDAR STREET
Second Line	:	YALE RHEUMATOLOGY, TAC S541
City	:	NEW HAVEN
State	:	CT
Zip	:	06520-8031
Country	:	US
Telephone Number	:	203-785-2454
Fax Number	:	202-785-7053

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	07/08/2007

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