Healthcare Provider Details

I. General information

NPI: 1740228824
Provider Name (Legal Business Name): LAWRENCE J FLIEGELMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 POST RD SUITE 302
FAIRFIELD CT
06824-6016
US

IV. Provider business mailing address

1305 POST RD SUITE 302
FAIRFIELD CT
06824-6016
US

V. Phone/Fax

Practice location:
  • Phone: 203-259-4700
  • Fax: 203-259-0328
Mailing address:
  • Phone: 203-259-4700
  • Fax: 203-259-0328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number039424
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: