Provider Demographics
NPI:1902850498
Name:LATTANZA, LISA L (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:L
Last Name:LATTANZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 COLLEGE ST FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3209
Mailing Address - Country:US
Mailing Address - Phone:032-785-5461
Mailing Address - Fax:
Practice Address - Street 1:47 COLLEGE ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3209
Practice Address - Country:US
Practice Address - Phone:203-785-5461
Practice Address - Fax:415-885-3862
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85464207X00000X, 207XS0106X
CT64343207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT64343OtherCT MEDICAL LICENSE
CA00G854640Medicaid
CA00G854640Medicare PIN