Serge P. Poulin, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

027117 Issued in CT

Legal business name

SERGE P. POULIN, MD

Practice address

629 E Middle Tpke
Manchester, CT 06040-3731

Phone

(860) 649-6900

Fax

(860) 647-0469

NPI assigned

Nov 8, 2011

Organization subpart

No

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

Authorized official

Name

Lousie Poulin

Title

Office Manager

Phone

(860) 649-6900

Specialties & licenses 1

Addresses

Other identifiers 1

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Serge P. Poulin, MD

  • Family Medicine Physician
  • Manchester, CT
  • NPI 1174712814
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Serge Peter Poulin, MD

  • Family Medicine Physician
  • Manchester, CT
  • NPI 1215954938
  NPD (past)

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

{
    "created_epoch": "1320710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320710400000",
    "number": "1770860504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "629 E MIDDLE TPKE",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060403731",
            "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": "629 E MIDDLE TPKE",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060403731",
            "telephone_number": "860-649-6900",
            "fax_number": "860-647-0469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERGE P. POULIN, MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-08",
        "last_updated": "2011-11-08",
        "status": "A",
        "authorized_official_last_name": "POULIN",
        "authorized_official_first_name": "LOUSIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "860-649-6900"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CT",
            "license": "027117",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0027117",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Self Love Therapy
• Elaine Sellenberg
• Jessica R Semmens
• Cesar Sepulveda
• Serge P. Poulin, MD
• Alyssa Marie Serra
• Katarina Serrano
• Sean Serrano, LMSW
• Kerian Service, M.D.
• Kylan Seville

• 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 Nov 8, 2011; 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.