Eriksen, Lance R

Eriksen, Lance R is an individual health care provider with primary practice located at 171 Grandview Ave Suite 103, Waterbury CT 06708-2517. He recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as his primary health care specialty. Eriksen, Lance R can be contacted via phone (203) 757-8919.

Contact Information

Primary practice address
171 Grandview Ave Suite 103 Waterbury CT 06708-2517
Phone: (203) 757-8919
Fax: (203) 756-4697
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 017909 Connecticut

Profile Details

NPI number 1891898821
LBN Legal business name Eriksen, Lance R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 6th, 2006
Last updated Mar 7th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1891898821 NPPES
Connecticut Other 070000092 MEDICARE PROVIDER #
Connecticut MEDICAID 001179092 MEDICARE PROVIDER #
Connecticut Other 13935 MEDICARE PROVIDER #

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