Organization
SERGE P. POULIN, MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LOUSIE POULIN (OFFICE MANAGER)
(860) 649-6900
Entity
Organization
Contact information
Practice address
629 E MIDDLE TPKE, MANCHESTER, CT 06040-3731
(860) 649-6900
(860) 647-0469
Mailing address
629 E MIDDLE TPKE, MANCHESTER, CT 06040-3731
(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
—
0027117
—
CT
Enumeration date
11/08/2011
Last updated
11/08/2011
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