Basic Information
Provider Information | |||||||||
NPI: | 1851770861 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LAHRMANN | ||||||||
FirstName: | JEFFREY | ||||||||
MiddleName: | PHILIP | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 35 TALCOTTVILLE RD STE 6 | ||||||||
Address2: |   | ||||||||
City: | VERNON | ||||||||
State: | CT | ||||||||
PostalCode: | 060665261 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8608706385 | ||||||||
FaxNumber: | 8608700625 | ||||||||
Practice Location | |||||||||
Address1: | 35 TALCOTTVILLE RD STE 6 | ||||||||
Address2: |   | ||||||||
City: | VERNON | ||||||||
State: | CT | ||||||||
PostalCode: | 060665261 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8608706385 | ||||||||
FaxNumber: | 8608700625 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/22/2015 | ||||||||
LastUpdateDate: | 09/07/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/07/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301107709 | MI | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 2084N0400X | MT210416 | PA | N |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | 1.062844-RES | CT | Y |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.