Healthcare Provider Details

I. General information

NPI: 1003876228
Provider Name (Legal Business Name): LISA KURIAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 E PUTNAM AVE STE 407
OLD GREENWICH CT
06870-1380
US

IV. Provider business mailing address

1700 E PUTNAM AVE STE 407
OLD GREENWICH CT
06870-1380
US

V. Phone/Fax

Practice location:
  • Phone: 203-524-9698
  • Fax: 203-242-4523
Mailing address:
  • Phone: 203-524-9698
  • Fax: 203-242-4523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number232576
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number047809
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number47809
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: