Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 043407 | CT |
NPI | 1659627479 |
---|---|
Provider Name | Mark Lobato |
First Address | Hartford, CT 06106-1367 |
Second Address | Hartford, CT 06106-1367 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2012 |
Last Update Date | 30/07/2012 |