Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | 022937 | CT |
NPI | 1053392951 |
---|---|
Provider Name | Jill Lacy |
First Address | New Haven, CT 06536-0805 |
Second Address | New Haven, CT 06519-1369 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2005 |
Last Update Date | 20/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001229376 | (05) | CT |
D85283 | (02) |