Individual
ALEX MERKULOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
263 FARMINGTON AVE, DIGNOSTIC RADIOLOGY, FARMINGTON, CT 06030-2803
(860) 679-2784
(860) 679-4126
Mailing address
263 FARMINGTON AVE, PROVIDER ENROLLMENT, FARMINGTON, CT 06030-2212
(860) 679-7503
(860) 679-1610
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
48417
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1982868550
—
CT
Enumeration date
07/14/2008
Last updated
09/30/2022
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