Healthcare Provider Details

I. General information

NPI: 1225146012
Provider Name (Legal Business Name): KATHLEEN A LAVORGNA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 08/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 CROSS ST #260
NORWALK CT
06851
US

IV. Provider business mailing address

30 STEVENS ST STE D
NORWALK CT
06850-3859
US

V. Phone/Fax

Practice location:
  • Phone: 203-845-2214
  • Fax: 203-845-2218
Mailing address:
  • Phone: 203-846-3338
  • Fax: 203-846-6010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number029808
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: