Individual
SATYA POLAVARAPU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
263 FARMINGTON AVE, FARMINGTON, CT 06030-2950
(860) 679-3387
(860) 679-1271
Mailing address
263 FARMINGTON AVE, PROVIDER ENROLLMENT, FARMINGTON, CT 06030-2212
(860) 679-7503
(860) 679-1610
Taxonomy
Speciality
Code
Description
License number
State
207VM0101X
Maternal & Fetal Medicine Physician
045351
CT
207VM0101X
Maternal & Fetal Medicine Physician
Primary
216058-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001453513
—
CT
Enumeration date
03/21/2006
Last updated
06/22/2016
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