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NPI Code Detail

MEDICARE: LAURA CELESTE BRENES MD

MEDICARE: LAURA CELESTE BRENES MD
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
1207R00000XInternal Medicine Physician046967CT

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00964331OTHERCTRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
39473362OTHERCTAETNA
4608892OTHERCTWELLCARE

General Provider Information

NPI Number : 1174795371
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA CELESTE BRENES MD
Provider Business Mailing Address
First Line : 76 BATTERSON PARK RD STE 106
Second Line :
City : FARMINGTON
State : CT
Zip : 06032-2571
Country : US
Telephone Number : 203-228-2097
Fax Number : 203-816-5564
Provider Business Practice Location Address
First Line : 76 BATTERSON PARK RD STE 106
Second Line :
City : FARMINGTON
State : CT
Zip : 06032-2571
Country : US
Telephone Number : 203-228-2097
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2008
Last Update Date : 02/04/2022

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Directions to “ LAURA CELESTE BRENES MD” Practice Location

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