Healthcare Provider Details

I. General information

NPI: 1891095188
Provider Name (Legal Business Name): LISA ANN WEISINGER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 YORK ST SUITE 2F
NEW HAVEN CT
06511-5620
US

IV. Provider business mailing address

100 YORK ST SUITE 2F
NEW HAVEN CT
06511-5620
US

V. Phone/Fax

Practice location:
  • Phone: 203-777-6455
  • Fax: 203-789-1960
Mailing address:
  • Phone: 203-777-6455
  • Fax: 203-789-1960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number040362
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: