Provider Demographics
NPI:1962223693
Name:LARA A. COLABELLI, DO, PLLC
Entity type:Organization
Organization Name:LARA A. COLABELLI, DO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:LARA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLABELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:475-317-4403
Mailing Address - Street 1:5 PEQUOT PARK RD STE 201A
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06498-2856
Mailing Address - Country:US
Mailing Address - Phone:475-317-4403
Mailing Address - Fax:
Practice Address - Street 1:5 PEQUOT PARK RD STE 201A
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:CT
Practice Address - Zip Code:06498-2856
Practice Address - Country:US
Practice Address - Phone:475-317-4403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty