Individual
NATHALIE LARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
400 COLUMBUS AVE, NEW HAVEN, CT 06519-1233
(203) 503-3292
(203) 781-0276
Mailing address
95 GRASSLANDS RD, VALHALLA, NY 10595-1652
(914) 909-0225
(203) 503-3254
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
044605
CT
2084P0800X
Psychiatry Physician
Primary
044605
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004235900
—
CT
05
—
004235918
—
CT
Enumeration date
12/05/2006
Last updated
12/17/2021
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