Individual
MARIE CARL EUGENE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
263 FARMINGTON AVE, NEUROLOGY MC-3835, FARMINGTON, CT 06030-3835
(860) 679-4888
(860) 679-1042
Mailing address
263 FARMINGTON AVE, PROVIDER ENROLLMENT, FARMINGTON, CT 06030-2212
(860) 679-4888
(860) 679-0131
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
049337
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1073703815
—
CT
Enumeration date
07/27/2007
Last updated
07/11/2022
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