Lisa C Alonso, MD
Individual provider Active NPI Pediatrics Physician · Middletown, CT
NPI 1093725970 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1093725970
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 031608 (CT)
- Practice address
- 400 Saybrook Rd
Suite 206
Middletown, CT 06457-4773 - Phone
- (860) 344-0333
- Fax
- (860) 344-9703
- NPI assigned
- Aug 9, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20031218000444 | CT | Practitioner - Pediatric Medicine | 5799682530 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 031608 | CT | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prohealth Physicians PC | Pediatrics | Current |
Accepting new patients |
Locations
3 Farm Glen Blvd
Farmington, CT 06032
Phone (860) 284-5200
4 Farm Springs Rd
Farmington, CT 06032
Phone (860) 284-5200
400 Saybrook Rd
Ste 206
Middletown, CT 06457
Phone (860) 344-0333
115 Spencer St
Winsted, CT 06098
Phone (860) 738-5810
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 031608 | CT | Yes |
Addresses
Primary practice location
400 Saybrook Rd
Suite 206
Middletown, CT 06457-4773
Mailing address
4 Farm Springs Rd
Prohealth Physicians
Farmington, CT 06032-2573
Phone (860) 284-5200
Other providers in Middletown, CT
- Align Therapy and Wellness
- All Care LLC
- Marilyn Sibrizzi Allatin
- William Mark Allen
- Jeanne Allison
- Jose Alvarez
- Rachel Ann Amatruda
- Paul Thomas Amble
- Kassidy Nicole Amburgey
- George Robert C Amilo
All providers in Middletown, CT · Pediatrics Physician in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.