Healthcare Provider Details

I. General information

NPI: 1366939977
Provider Name (Legal Business Name): LYUDMILA BURINA GANATRA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 E PUTNAM AVE STE 1
OLD GREENWICH CT
06870-1360
US

IV. Provider business mailing address

1455 E PUTNAM AVE STE 1
OLD GREENWICH CT
06870-1360
US

V. Phone/Fax

Practice location:
  • Phone: 203-637-3337
  • Fax: 203-637-3307
Mailing address:
  • Phone: 203-637-3337
  • Fax: 203-637-3307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number72830
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: