Individual
CARISSA A WEBSTER-LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2550 ALBANY AVE # 1056, WEST HARTFORD, CT 06117-2335
(617) 869-0135
Mailing address
2550 ALBANY AVE # 1056, WEST HARTFORD, CT 06117-2335
(901) 271-0155
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
54698
CT
2086S0129X
Vascular Surgery Physician
0101279557
VA
2086S0129X
Vascular Surgery Physician
54698
CT
2086S0129X
Vascular Surgery Physician
Primary
59921
TN
Other
Enumeration date
05/28/2010
Last updated
08/28/2024
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