Healthcare Provider Details

I. General information

NPI: 1134228158
Provider Name (Legal Business Name): JEFFREY M LAUT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 06/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SEYMOUR ST SUITE 900
HARTFORD CT
06106
US

IV. Provider business mailing address

2110 SILAS DEANE HWY
ROCKY HILL CT
06067
US

V. Phone/Fax

Practice location:
  • Phone: 860-241-0700
  • Fax: 860-525-7881
Mailing address:
  • Phone: 860-258-3470
  • Fax: 860-571-6800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number028782
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number028782
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: