Healthcare Provider Details

I. General information

NPI: 1104212570
Provider Name (Legal Business Name): RAYMOND PAUL LORENZONI III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2015
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 BOSTON POST RD W B
WESTPORT CT
06880
US

IV. Provider business mailing address

282 WASHINGTON ST STE 2B
HARTFORD CT
06106-3322
US

V. Phone/Fax

Practice location:
  • Phone: 203-451-7432
  • Fax:
Mailing address:
  • Phone: 860-545-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number72019
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number72019
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: