Provider Demographics
NPI:1285776708
Name:BRAILEY, LISA LOUISE (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:LOUISE
Last Name:BRAILEY
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 1:21 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418-1615
Mailing Address - Country:US
Mailing Address - Phone:203-906-6883
Mailing Address - Fax:
Practice Address - Street 1:1 FOREST PKWY
Practice Address - Street 2:DIANON SYSTEMS
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-6147
Practice Address - Country:US
Practice Address - Phone:203-926-7124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT041659207SC0300X, 207SG0201X, 207SG0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0203XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Molecular Genetics
No207SC0300XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Cytogenetics
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)