Individual
MARK E LUSTBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
20 YORK ST, NEW HAVEN, CT 06510-3220
(203) 688-5523
(203) 688-3216
Mailing address
117 RANDI DR, MADISON, CT 06443-2483
(410) 375-3160
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
67997
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2954478
—
OH
Enumeration date
04/04/2007
Last updated
01/27/2022
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