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General NPI Number Information
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NPI Number | 1881688034
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Entity Type | Individual
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Provider Name | MARYANNA POLUKHIN M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/02/2005
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 18 CEDAR ST GROVE HILL MEDICAL CENTER
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City | NEWINGTON
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State | CT
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Zip | 06111-2647
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Country | US
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Telephone | 860-666-5252
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Fax | 860-666-5153
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Provider Business Mailing Address
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Address Line | 300 KENSINGTON AVE GROVE HILL MEDICAL CENTER
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City | NEW BRITAIN
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State | CT
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Zip | 06051-3916
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Country | US
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Telephone | 860-666-5252
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Fax | 860-666-5153
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 034968
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License Number State | CT
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