Healthcare Provider Details

I. General information

NPI: 1710974738
Provider Name (Legal Business Name): LAWRENCE M PARELES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 HEBRON AVE
GLASTONBURY CT
06033-5000
US

IV. Provider business mailing address

2110 SILAS DEANE HWY
ROCKY HILL CT
06067-2313
US

V. Phone/Fax

Practice location:
  • Phone: 860-659-8830
  • Fax:
Mailing address:
  • Phone: 860-258-3470
  • Fax: 860-571-6800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number020724
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: