Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 036697 | CT |
Y | 207X00000X | Orthopaedic Surgeon | 36697 | CT |
N | 207XS0106X | Orthopaedic Hand Surgeon | 36697 | CT |
NPI | 1336107176 |
---|---|
Provider Name | Mark David Lorenze |
First Address | Hamden, CT 06518-3209 |
Second Address | Essex, CT 06426-1500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2006 |
Last Update Date | 23/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G56124 | (02) | CT |