Basic Information
| Provider Information | |||||||||
| NPI: | 1609075324 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LODATO | ||||||||
| FirstName: | CAROLINE | ||||||||
| MiddleName: | KIERNAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KIERNAN | ||||||||
| OtherFirstName: | CAROLINE | ||||||||
| OtherMiddleName: | ANN | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5 PERRYRIDGE RD | ||||||||
| Address2: | GREENWICH HOSPITAL | ||||||||
| City: | GREENWICH | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068304697 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2038633840 | ||||||||
| FaxNumber: | 2038633467 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 PERRYRIDGE RD | ||||||||
| Address2: | GREENWICH HOSPITAL | ||||||||
| City: | GREENWICH | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068304697 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2038633840 | ||||||||
| FaxNumber: | 2038633467 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2007 | ||||||||
| LastUpdateDate: | 08/22/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 15760 | NH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 051759 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0002X | 051759 | CT | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine |
No ID Information.