MEDICARE: DR. ERIC T LAO MD

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	207R00000X	Internal Medicine Physician	209983	MA

General Provider Information

NPI Number	:	1801878681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC T LAO MD

Provider Business Mailing Address
First Line	:	216 HEMLOCK AVE STE 104
Second Line	:
City	:	SOUTH WINDSOR
State	:	CT
Zip	:	06074-9607
Country	:	US
Telephone Number	:	860-697-6565
Fax Number	:

Provider Business Practice Location Address
First Line	:	216 HEMLOCK AVE STE 104
Second Line	:
City	:	SOUTH WINDSOR
State	:	CT
Zip	:	06074-9607
Country	:	US
Telephone Number	:	860-697-6565
Fax Number	:	860-730-4661

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

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	06/22/2021

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