Healthcare Provider Details

I. General information

NPI: 1508950247
Provider Name (Legal Business Name): LORNA M SEYBOLT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 WHITNEY AVE STE 290
HAMDEN CT
06518-3695
US

IV. Provider business mailing address

2200 WHITNEY AVE STE 290
HAMDEN CT
06518-3695
US

V. Phone/Fax

Practice location:
  • Phone: 203-903-8308
  • Fax: 203-599-3927
Mailing address:
  • Phone: 203-903-8308
  • Fax: 203-599-3927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number77094
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number77094
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: