Healthcare Provider Details

I. General information

NPI: 1427038181
Provider Name (Legal Business Name): EILEEN M LAWRENCE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 E MAIN ST
CLINTON CT
06413-2116
US

IV. Provider business mailing address

162 E MAIN ST
CLINTON CT
06413-2116
US

V. Phone/Fax

Practice location:
  • Phone: 860-669-7272
  • Fax: 860-669-3337
Mailing address:
  • Phone: 860-669-7272
  • Fax: 860-669-3337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number036800
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: