Healthcare Provider Details

I. General information

NPI: 1114000965
Provider Name (Legal Business Name): NEW BRITAIN PEDIATRIC GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 09/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 WEST MAIN STREET
NEW BRITAIN CT
06053
US

IV. Provider business mailing address

1095 WEST MAIN STREET
NEW BRITAIN CT
06053
US

V. Phone/Fax

Practice location:
  • Phone: 860-826-5430
  • Fax: 860-229-1072
Mailing address:
  • Phone: 860-826-5430
  • Fax: 860-229-1072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN LAMOUREUX
Title or Position: PEDIATRICIAN
Credential: M.D.
Phone: 860-225-6064