Individual
LYNN STREET
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
100 YORK ST, SUITE 2E, NEW HAVEN, CT 06511
(203) 787-3588
(203) 777-3767
Mailing address
100 YORK ST, SUITE 2E, NEW HAVEN, CT 06511
(203) 787-3588
(203) 777-3767
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
031188
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001311886
—
CT
01
—
010031188CT05
ANTHEM BCBS
—
01
—
2786505
AETNA HEALTH PLAN
—
01
—
2V6941
HEALTHNET
—
01
—
755255
CONNECTCARE
—
01
—
9389988
CIGNA
—
01
—
P2685931
OXFORD
—
Enumeration date
05/23/2006
Last updated
10/26/2012
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