Active NPI
Lisa O'Donovan, MD
- Internal Medicine Physician
- Newington, CT
National Provider Identifier
1194380949
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 70764
- Practice address
- 555 Willard Ave
Newington, CT 06111-2631 - Phone
- (866) 808-7921
- NPI assigned
- May 7, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 70764 | CT | Primary |
Addresses
Primary practice location
555 Willard Ave
Newington, CT 06111-2631
Mailing address
555 Willard Ave
Newington, CT 06111-2631
Phone (866) 808-7921
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190627002527 | CT | Order and Referring Only - Internal Medicine | 7719211598 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1557187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692835200000",
"number": "1194380949",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "555 WILLARD AVE",
"city": "NEWINGTON",
"state": "CT",
"postal_code": "061112631",
"telephone_number": "866-808-7921"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "555 WILLARD AVE",
"city": "NEWINGTON",
"state": "CT",
"postal_code": "061112631",
"telephone_number": "866-808-7921"
}
],
"practiceLocations": [],
"basic": {
"last_name": "O'DONOVAN",
"first_name": "LISA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-05-07",
"last_updated": "2023-08-24",
"certification_date": "2023-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "CT",
"license": "70764",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newington, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.