Basic Information
Provider Information
NPI: 1578549366
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CANTLEY
FirstName: LLOYD
MiddleName: GARNET
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 9805
Address2: 300 GEORGE STREET 6TH FLOOR
City: NEW HAVEN
State: CT
PostalCode: 065360805
CountryCode: US
TelephoneNumber: 2037857998
FaxNumber: 2037856414
Practice Location
Address1: 800 HOWARD AVENUE
Address2:  
City: NEW HAVEN
State: CT
PostalCode: 06519
CountryCode: US
TelephoneNumber: 2037852140
FaxNumber: 2037856414
Other Information
ProviderEnumerationDate: 12/22/2005
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RN0300X038582CTY Allopathic & Osteopathic PhysiciansInternal MedicineNephrology

No ID Information.


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