Individual
MR. SERGE PETER POULIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
315 E. CENTER ST, MANCHESTER, CT 06040
(860) 649-6900
(860) 647-0469
Mailing address
315 E. CENTER ST, MANCHESTER, CT 06040
(860) 649-6900
(860) 647-0469
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
027117
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001271171
—
CT
05
—
027117
—
CT
Enumeration date
07/17/2006
Last updated
05/11/2010
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