Basic Information
| Provider Information | |||||||||
| NPI: | 1558367359 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HILLIS | ||||||||
| FirstName: | LYNNE | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1453 WHALLEY AVE | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065151153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033894111 | ||||||||
| FaxNumber: | 2038894953 | ||||||||
| Practice Location | |||||||||
| Address1: | 1453 WHALLEY AVE | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065151153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033894111 | ||||||||
| FaxNumber: | 2038894953 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2005 | ||||||||
| LastUpdateDate: | 05/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 05/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 031055 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0013110557 | 05 | CT | MEDICAID | P404271 | 01 | CT | OXFORD | OTHER | 031055 | 01 | CT | CONNECTICARE | OTHER | 0470255 | 01 | CT | AETNA | OTHER | 110169706 | 01 | CT | MEDICARE RAILROAD | OTHER | D400104641 | 01 | CT | MEDICARE ID | OTHER | 010031055CT01 | 01 | CT | ANTHEM | OTHER | OV7607 | 01 | CT | HEALTHNET | OTHER |