Basic Information
| Provider Information | |||||||||
| NPI: | 1144207655 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHUCK | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1060 DAY HILL RD | ||||||||
| Address2: | |||||||||
| City: | WINDSOR | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060955719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606832690 | ||||||||
| FaxNumber: | 8606832670 | ||||||||
| Practice Location | |||||||||
| Address1: | 1060 DAY HILL RD | ||||||||
| Address2: | |||||||||
| City: | WINDSOR | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060955719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606832690 | ||||||||
| FaxNumber: | 8606832670 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2005 | ||||||||
| LastUpdateDate: | 05/21/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 41101 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 001411016 | 05 | CT | MEDICAID | 1144207655 | 01 | CT | NPI | OTHER |