Serge Peter Poulin, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

027117 Issued in CT

Practice address

315 E. Center St
Manchester, CT 06040

Phone

(860) 649-6900

Fax

(860) 647-0469

NPI assigned

Jul 17, 2006

Last updated

May 11, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Serge P. Poulin, MD

  • Family Medicine Physician
  • Manchester, CT
  • NPI 1770860504
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1273536000000",
    "number": "1215954938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 E. CENTER ST",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "06040",
            "telephone_number": "860-649-6900",
            "fax_number": "860-647-0469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 E. CENTER ST",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "06040",
            "telephone_number": "860-649-6900",
            "fax_number": "860-647-0469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POULIN",
        "first_name": "SERGE",
        "middle_name": "PETER",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2010-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CT",
            "license": "027117",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "027117",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001271171",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alessandra Popolizio
• Terry M Poppiti, APRN
• Michael John Portal, PA-C
• Russell David Posner, MD
• Natalie Lynn Possum, LPC-A
• Lauren Powers
• Michael Powers, M.S.W., L.C.S.W.
• Amber SM Pragosa
• Lucia Pratto
• Lisa Preble, LADC, LCSW

• Family Medicine Physician in Manchester, CT
• Providers in Manchester, CT by specialty
• Family Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.