# SERGE P. POULIN, MD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770860504
- **Authorized official:** LOUSIE POULIN (OFFICE MANAGER)
- **Authorized official phone:** (860) 649-6900

## Contact information

- **Practice address:** 629 E MIDDLE TPKE, MANCHESTER, CT 06040-3731
- **Practice address phone:** (860) 649-6900
- **Practice address fax:** (860) 647-0469
- **Mailing address:** 629 E MIDDLE TPKE, MANCHESTER, CT 06040-3731
- **Mailing address phone:** (860) 649-6900
- **Mailing address fax:** (860) 647-0469

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 027117 | CT | Yes |

## Other

- **Enumeration date:** 11/08/2011
- **Last updated:** 11/08/2011