Individual
LISA CHIRCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
263 FARMINGTON AVE, INFECTIOUS DISEASES, FARMINGTON, CT 06030-2817
(860) 679-4225
(860) 679-1217
Mailing address
263 FARMINGTON AVE, PROVIDER ENROLLMENT OFFICE, FARMINGTON, CT 06030-2212
(860) 679-7503
(860) 679-1610
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
050203
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1528098985
—
CT
Enumeration date
07/03/2006
Last updated
09/26/2022
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