Individual
DR. LANCE R ERIKSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
171 GRANDVIEW AVE, SUITE 103, WATERBURY, CT 06708-2517
(203) 757-8919
(203) 756-4697
Mailing address
171 GRANDVIEW AVE, SUITE 103, WATERBURY, CT 06708-2517
(203) 757-8919
(203) 756-4697
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
017909
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001179092
—
CT
01
—
070000092
MEDICARE PROVIDER #
CT
01
—
13935
STATE CONTROLED SUB
—
Enumeration date
09/06/2006
Last updated
03/07/2023
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