Healthcare Provider Details

I. General information

NPI: 1760581441
Provider Name (Legal Business Name): MALGORZATA KOWALSKA-BERGER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 HART ST DOOR C
NEW BRITAIN CT
06052
US

IV. Provider business mailing address

40 HART ST DOOR C
NEW BRITAIN CT
06052
US

V. Phone/Fax

Practice location:
  • Phone: 860-223-6989
  • Fax: 860-223-2947
Mailing address:
  • Phone: 860-223-6989
  • Fax: 860-223-2947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number022819
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: