Healthcare Provider Details

I. General information

NPI: 1376562322
Provider Name (Legal Business Name): CHRISTINE LAMOUREUX MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE LAMOUREUX MD

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 12/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 W MAIN ST
NEW BRITAIN CT
06053-3455
US

IV. Provider business mailing address

1095 W MAIN ST
NEW BRITAIN CT
06053-3455
US

V. Phone/Fax

Practice location:
  • Phone: 860-225-6064
  • Fax: 860-229-1072
Mailing address:
  • Phone: 860-225-6064
  • Fax: 860-229-1072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number038522
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: