Individual
DR. MARYANNA POLUKHIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
18 CEDAR ST, GROVE HILL MEDICAL CENTER, NEWINGTON, CT 06111-2647
(860) 666-5252
(860) 666-5153
Mailing address
300 KENSINGTON AVE, GROVE HILL MEDICAL CENTER, NEW BRITAIN, CT 06051-3916
(860) 666-5252
(860) 666-5153
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
034968
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001349689
—
CT
05
—
004215324
—
CT
01
—
010034968CT04
BCBS & BCFP PROV ID
CT
01
—
01034968
CIGNA
CT
01
—
060118
HEALTH NET
CT
01
—
110182439
RAIL ROAD MEDICARE
CT
01
—
1255448155
GHMC GROUP NPI ID
CT
01
—
349680
CONNECTICARE
CT
01
—
5247130
AETNA
CT
01
—
P369816
OXFORD
CT
Enumeration date
09/02/2005
Last updated
07/09/2007
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