Provider Demographics
NPI:1962615922
Name:CERVANTES, LORENZO J (MD)
Entity type:Individual
Prefix:DR
First Name:LORENZO
Middle Name:J
Last Name:CERVANTES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4 CORPORATE DR STE 380
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-6266
Mailing Address - Country:US
Mailing Address - Phone:203-926-1700
Mailing Address - Fax:203-926-0766
Practice Address - Street 1:4 CORPORATE DR STE 380
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-6266
Practice Address - Country:US
Practice Address - Phone:203-261-7009
Practice Address - Fax:039-260-7662
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2024-11-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT49775207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1962615922Medicaid
CT1962615922Medicare NSC