Individual
MARK JASON POLATNICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
41 N MAIN ST, SUITE 300, WEST HARTFORD, CT 06107-1972
(860) 313-0448
(860) 313-1464
Mailing address
41 N MAIN ST, SUITE 300, WEST HARTFORD, CT 06107-1972
(860) 313-0448
(860) 313-1464
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
038683
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010038683CT02
ANTHEM BLUE SHIELD
CT
05
—
1376562090
—
CT
01
—
3V0199
HEALTHNET
—
Enumeration date
07/19/2006
Last updated
06/21/2021
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