Healthcare Provider Details

I. General information

NPI: 1437168457
Provider Name (Legal Business Name): MARLENE L. WARADZIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 CENTER ST SUITE H
WALLINGFORD CT
06492-4100
US

IV. Provider business mailing address

185 CENTER ST SUITE H
WALLINGFORD CT
06492-4100
US

V. Phone/Fax

Practice location:
  • Phone: 203-284-1060
  • Fax: 203-284-4981
Mailing address:
  • Phone: 203-284-1060
  • Fax: 203-284-4981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number031062
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: