Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 037659 | CT |
N | 207XS0106X | Orthopaedic Hand Surgeon | 037659 | CT |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 037659 | CT |
N | 207XS0117X | Orthopaedic Spine Surgeon | 037659 | CT |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 037659 | CT |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 037659 | CT |
N | 207XX0801X | Orthopaedic Trauma Surgeon | 037659 | CT |
NPI | 1407942006 |
---|---|
Provider Name | Lawrence Berson |
First Address | Middletown, CT 06457-4777 |
Second Address | Middletown, CT 06457-4777 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 05/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001376591 | (05) | CT |
G90712 | (02) |