Provider Demographics
NPI:1316943228
Name:WRIGHT, LAVERN A (MD)
Entity type:Individual
Prefix:
First Name:LAVERN
Middle Name:A
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:263 FARMINGTON AVE
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-2212
Mailing Address - Country:US
Mailing Address - Phone:860-679-7503
Mailing Address - Fax:860-679-1610
Practice Address - Street 1:263 FARMINGTON AVE
Practice Address - Street 2:GERIATRIC MEDICINE
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-0001
Practice Address - Country:US
Practice Address - Phone:860-679-8400
Practice Address - Fax:860-679-1867
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2022-09-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT042848207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1428483Medicaid
CTI29318Medicare UPIN
CT1428483Medicaid