MEDICARE: LAD FAMILY FIRST

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	171W00000X	Contractor	1806090000	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881814960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAD FAMILY FIRST

Provider Business Mailing Address
First Line	:	994 NORTH COLONY RD
Second Line	:	SUITE #343
City	:	WALLINGFORD
State	:	CT
Zip	:	06492-5902
Country	:	US
Telephone Number	:	203-269-5552
Fax Number	:	203-265-3512

Provider Business Practice Location Address
First Line	:	999 NORTH COLONY RD
Second Line	:	SUITE 343
City	:	WALLINGFORD
State	:	CT
Zip	:	06492-5902
Country	:	US
Telephone Number	:	203-269-5552
Fax Number	:	203-265-3512

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	MRS. LYNN ANN DEAN
Credential	:
Telephone Number	:	203-269-5552

Provider Enumeration Date	:	04/30/2007
Last Update Date	:	09/20/2007

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Directions to “LAD FAMILY FIRST ” Practice Location

Language	Start Address	Practice Location

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