NPIMap

Olga Andreyevna Bulygina, MD

Individual provider Active NPI Pediatrics Physician · South Windsor, CT

NPI 1962554550 · NPPES record last updated Oct 11, 2024

Key facts

NPI
1962554550
Entity type
Individual (NPI type 1)
Primary specialty
Pediatrics Physician 208000000X
License
044577 (CT)
Practice address
2701 Tamarack Ave
South Windsor, CT 06074-5562
Phone
(860) 647-8282
Fax
(860) 647-8399
NPI assigned
Jan 17, 2007
Sex
Female
Sole proprietor
Yes

Organizations & group practices 1

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

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
044577CTMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kids Station Pediatrics Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: olga.bulygina.1@30283.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/14085/brand/1/csg/1/fhir/r4

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 044577 CT Yes

Addresses

Primary practice location

2701 Tamarack Ave
South Windsor, CT 06074-5562

Mailing address

2701 Tamarack Ave
South Windsor, CT 06074-5562
Phone (860) 647-8282

Other providers in South Windsor, CT

All providers in South Windsor, CT · Pediatrics Physician in Connecticut

Sources for this page

Verify at the official NPI Registry.