Provider Demographics
NPI:1396803649
Name:NAZARETH, LUMINA MARY (MD)
Entity type:Individual
Prefix:
First Name:LUMINA
Middle Name:MARY
Last Name:NAZARETH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:SOUTHWEST CT MENTAL HEALTH SYSTEM ATTN SANDRA GRAZYNSKI
Mailing Address - Street 2:1635 CENTRAL AVENUE ROOM 213
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610
Mailing Address - Country:US
Mailing Address - Phone:203-551-7660
Mailing Address - Fax:203-551-7481
Practice Address - Street 1:SOUTHWEST CT MENTAL HEALTH SYSTEM ATTN SANDRA GRAZYNSKI
Practice Address - Street 2:1635 CENTRAL AVENUE ROOM 213
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610
Practice Address - Country:US
Practice Address - Phone:203-551-7660
Practice Address - Fax:203-551-7481
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT038262207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H12003Medicare UPIN