Healthcare Provider Details

I. General information

NPI: 1336129717
Provider Name (Legal Business Name): CAROL S PAPOV M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 PARK LANE RD UNIT B202
NEW MILFORD CT
06776-2444
US

IV. Provider business mailing address

120 PARK LANE RD UNIT B202
NEW MILFORD CT
06776-2444
US

V. Phone/Fax

Practice location:
  • Phone: 860-210-0082
  • Fax: 860-210-1633
Mailing address:
  • Phone: 860-210-0082
  • Fax: 860-210-1633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0.7903
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: