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General NPI Number Information
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NPI Number | 1336122100
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF CONNECTICUT HEALTH CENTER
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Dates
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Enumeration Date | 11/25/2005
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Last Update Date | 11/17/2015
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Provider Practice Location Address
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Address Line | 21 SOUTH RD DERMATOPATHOLOGY LABORATORY
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City | FARMINGTON
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State | CT
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Zip | 06032-2482
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Country | US
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Telephone | 860-679-4600
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Fax | 860-679-1248
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Provider Business Mailing Address
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Address Line | 263 FARMINGTON AVE PROVIDER ENROLLMENT
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City | FARMINGTON
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State | CT
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Zip | 06030-2212
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Country | US
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Telephone | 860-679-7503
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Fax | 860-679-1610
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DENIS C LAFRENIERE
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Credential | MD
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Telephone | 860-679-7503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 021687
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License Number State | CT
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