Healthcare Provider Details

I. General information

NPI: 1861408619
Provider Name (Legal Business Name): FLANDERS PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 BOSTON POST RD
EAST LYME CT
06333-0278
US

IV. Provider business mailing address

131 BOSTON POST RD
EAST LYME CT
06333-0278
US

V. Phone/Fax

Practice location:
  • Phone: 860-739-0348
  • Fax: 860-739-6779
Mailing address:
  • Phone: 860-739-0348
  • Fax: 860-739-6779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number034568
License Number StateCT

VIII. Authorized Official

Name: MARIA A LOPEZ
Title or Position: PHYSICIAN/OWNER OF PRACTICE
Credential: MD
Phone: 800-739-0348