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NPI Code Detail

MEDICARE: DR. LAURA DIANEY IBANEZ MD

MEDICARE: DR. LAURA DIANEY IBANEZ 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
1208M00000XHospitalist Physician83025CT

General Provider Information

NPI Number : 1417659517
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LAURA DIANEY IBANEZ MD
Provider Business Mailing Address
First Line : 300 SEASIDE AVE
Second Line :
City : MILFORD
State : CT
Zip : 06460-4603
Country : US
Telephone Number : 203-876-4000
Fax Number :
Provider Business Practice Location Address
First Line : 300 SEASIDE AVE
Second Line :
City : MILFORD
State : CT
Zip : 06460-4603
Country : US
Telephone Number : 204-876-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2023
Last Update Date : 06/02/2026

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