Provider Demographics
NPI:1174548838
Name:LERNER, SETH PERRY (MD)
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:PERRY
Last Name:LERNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 HAWLEY LN
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-5300
Mailing Address - Country:US
Mailing Address - Phone:203-377-0639
Mailing Address - Fax:
Practice Address - Street 1:160 HAWLEY LN
Practice Address - Street 2:SUITE 104
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-5300
Practice Address - Country:US
Practice Address - Phone:203-377-0639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT027384207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT070003581OtherMEDICARE RAILROAD
CTB38248Medicare UPIN
CT070000146Medicare ID - Type Unspecified