MEDICARE: DR. DIANA LOPUSNY M.D.

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	208000000X	Pediatrics Physician	042248	CT
2	2080A0000X	Pediatric Adolescent Medicine Physician	042248	CT

General Provider Information

NPI Number	:	1528012549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANA LOPUSNY M.D.

Provider Business Mailing Address
First Line	:	88 NOBLE AVE
Second Line	:	SUITE 101
City	:	MILFORD
State	:	CT
Zip	:	06460-4738
Country	:	US
Telephone Number	:	203-874-2800
Fax Number	:	203-874-0511

Provider Business Practice Location Address
First Line	:	88 NOBLE AVE
Second Line	:	SUITE 101
City	:	MILFORD
State	:	CT
Zip	:	06460-4738
Country	:	US
Telephone Number	:	203-874-2800
Fax Number	:	203-874-0511

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	03/23/2012

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