Healthcare Provider Details

I. General information

NPI: 1235588997
Provider Name (Legal Business Name): RICHARD J LAVOIE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 LAFAYETTE ST
NORWICH CT
06360-3407
US

IV. Provider business mailing address

27 LAFAYETTE ST
NORWICH CT
06360-3407
US

V. Phone/Fax

Practice location:
  • Phone: 860-887-1316
  • Fax: 860-887-1418
Mailing address:
  • Phone: 860-887-1316
  • Fax: 860-887-1418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD J LAVOIE
Title or Position: SOLE PROPIETOR
Credential: M.D.
Phone: 860-887-1316