Healthcare Provider Details

I. General information

NPI: 1982223426
Provider Name (Legal Business Name): ELIZABETH PAN CAI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2020
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 INDIAN RIVER RD STE B1
ORANGE CT
06477-3690
US

IV. Provider business mailing address

240 INDIAN RIVER RD STE B1
ORANGE CT
06477-3690
US

V. Phone/Fax

Practice location:
  • Phone: 203-795-6025
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number75133
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: