Healthcare Provider Details

I. General information

NPI: 1164488094
Provider Name (Legal Business Name): EUGENE SAPOZHNIKOV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: EUGENE SAPOZHNIKOV M.D.

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234A BANK ST
NEW LONDON CT
06320-6054
US

IV. Provider business mailing address

234A BANK STREET 4TH FLOOR
NEW LONDON CT
06320-6054
US

V. Phone/Fax

Practice location:
  • Phone: 860-442-0290
  • Fax: 860-442-2136
Mailing address:
  • Phone: 860-442-0290
  • Fax: 860-442-2136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number038561
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: