MEDICARE: ELCG MEDICAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332900000X	Non-Pharmacy Dispensing Site

General Provider Information

NPI Number	:	1073389029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELCG MEDICAL LLC

Provider Business Mailing Address
First Line	:	6 NORTHWESTERN DR STE 105
Second Line	:
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-3416
Country	:	US
Telephone Number	:	860-917-0019
Fax Number	:	833-449-5031

Provider Business Practice Location Address
First Line	:	6 NORTHWESTERN DR STE 105
Second Line	:
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-3416
Country	:	US
Telephone Number	:	860-917-0019
Fax Number	:	833-449-5031

Authorized Official
Title or Position	:	MD/OWNER
Name	:	DR. ERICA H LAMBERT
Credential	:	MD
Telephone Number	:	917-837-9215

Provider Enumeration Date	:	11/30/2023
Last Update Date	:	11/30/2023

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