Healthcare Provider Details

I. General information

NPI: 1659420719
Provider Name (Legal Business Name): LAUREN JAMIE EHRLICH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CEDAR ST
NEW HAVEN CT
06510-3206
US

IV. Provider business mailing address

333 CEDAR ST P.O. BOX 208042
NEW HAVEN CT
06510-3206
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-2688
  • Fax: 203-785-4328
Mailing address:
  • Phone: 203-785-2688
  • Fax: 203-785-4328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMT186759
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2011-00319
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number50502
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: