Healthcare Provider Details

I. General information

NPI: 1992293757
Provider Name (Legal Business Name): SAMANTHA JOY LACROCE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2018
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W MAIN ST
WATERBURY CT
06708-3105
US

IV. Provider business mailing address

2661 RIVA RD STE 1030
ANNAPOLIS MD
21401-7131
US

V. Phone/Fax

Practice location:
  • Phone: 203-597-9100
  • Fax: 203-573-4805
Mailing address:
  • Phone: 667-354-5528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD476784
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number84320
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number239366
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: