MEDICARE: L&M PHYSICIAN ASSOCIATION, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	207R00000X	Internal Medicine Physician
2	207RC0000X	Cardiovascular Disease Physician
3	208600000X	Surgery Physician
4	208100000X	Physical Medicine & Rehabilitation Physician
5	207T00000X	Neurological Surgery Physician
6	2084P0800X	Psychiatry Physician	CT
7	101YM0800X	Mental Health Counselor
8	1041C0700X	Clinical Social Worker
9	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
10	106H00000X	Marriage & Family Therapist
11	363LF0000X	Family Nurse Practitioner
12	207Q00000X	Family Medicine Physician

Other Identifiers

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

General Provider Information

NPI Number	:	1386972693
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	L&M PHYSICIAN ASSOCIATION, INC

Provider Business Mailing Address
First Line	:	2 LORENZ INDUSTRIAL PKWY
Second Line	:
City	:	LEDYARD
State	:	CT
Zip	:	06339-1946
Country	:	US
Telephone Number	:	860-464-3045
Fax Number	:	860-464-3044

Provider Business Practice Location Address
First Line	:	2 LORENZ INDUSTRIAL PKWY
Second Line	:
City	:	LEDYARD
State	:	CT
Zip	:	06339-1946
Country	:	US
Telephone Number	:	860-464-3045
Fax Number	:	860-464-3044

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	PAMELA KANE
Credential	:
Telephone Number	:	860-442-0711

Provider Enumeration Date	:	11/24/2009
Last Update Date	:	05/08/2013

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