1528162146 NPI number — LISA SUSAN BAKER APRN

Table of content: DR. HOWARD HAUSMAN DDS (NPI 1942214424)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528162146 NPI number — LISA SUSAN BAKER APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAKER
Provider First Name:
LISA
Provider Middle Name:
SUSAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528162146
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 415933
Provider Second Line Business Mailing Address:
HARTFORD HOSPITAL PROFESSIONAL SERVICES
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
00224-5933
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-545-7602
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 SEYMOUR STREET
Provider Second Line Business Practice Location Address:
HARTFORD HOSPIAL SURGERY DEPT
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06102-5037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-545-2840
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WG0100X , with the licence number:  001890 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2100X , with the licence number: 001890 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 004018908 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".