Healthcare Provider Details

I. General information

NPI: 1588018030
Provider Name (Legal Business Name): SARA ELIZABETH LACHANCE D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 SHAWS CV STE 204
NEW LONDON CT
06320-4956
US

IV. Provider business mailing address

59 WOODVILLE ALTON RD
WOOD RIVER JUNCTION RI
02894-1113
US

V. Phone/Fax

Practice location:
  • Phone: 860-447-2377
  • Fax:
Mailing address:
  • Phone: 401-323-1075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number64973
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: