Healthcare Provider Details

I. General information

NPI: 1639335201
Provider Name (Legal Business Name): LISA A DELSIGNORE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PARK ST
NEW HAVEN CT
06504-8901
US

IV. Provider business mailing address

1 PARK ST
NEW HAVEN CT
06504-8901
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-4081
  • Fax: 203-737-7635
Mailing address:
  • Phone: 203-785-4081
  • Fax: 203-737-7635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD442374
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number78222
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number250445
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: