Healthcare Provider Details

I. General information

NPI: 1295222784
Provider Name (Legal Business Name): EMILY J ANSTADT LUTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 RETREAT AVE
HARTFORD CT
06106-2555
US

IV. Provider business mailing address

85 RETREAT AVE
HARTFORD CT
06106-2555
US

V. Phone/Fax

Practice location:
  • Phone: 608-972-2803
  • Fax:
Mailing address:
  • Phone: 860-972-2803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number73055
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: