Provider Demographics
NPI:1902805781
Name:LAGUARDIA, RALPH J (MD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:J
Last Name:LAGUARDIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10 HIGGINS HWY
Mailing Address - Street 2:STE 4
Mailing Address - City:MANSFIELD CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06250-1437
Mailing Address - Country:US
Mailing Address - Phone:860-456-7101
Mailing Address - Fax:860-423-0464
Practice Address - Street 1:10 HIGGINS HWY
Practice Address - Street 2:STE 4
Practice Address - City:MANSFIELD CENTER
Practice Address - State:CT
Practice Address - Zip Code:06250-1437
Practice Address - Country:US
Practice Address - Phone:860-456-7101
Practice Address - Fax:860-423-0464
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT029002207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001290022Medicaid
CT001290022Medicaid
D02816Medicare UPIN