Basic Information
| Provider Information | |||||||||
| NPI: | 1639303373 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOTT | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | PELHAM | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D., M.S.H.P. M.H.S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 428 COLUMBUS AVE | ||||||||
| Address2: | P.O. BOX 208059 | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065191233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035033000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 428 COLUMBUS AVE | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065191233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035033000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2009 | ||||||||
| LastUpdateDate: | 03/21/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MT194913 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 390200000X | MT194913 | PA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207N00000X | 051084 | CT | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.