Provider Demographics
NPI:1306979257
Name:KOLAKOWSKA, LUCYNA T (MD)
Entity type:Individual
Prefix:
First Name:LUCYNA
Middle Name:T
Last Name:KOLAKOWSKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LUCYNA
Other - Middle Name:T
Other - Last Name:KOLAKOWSKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:247 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052
Mailing Address - Country:US
Mailing Address - Phone:860-826-7597
Mailing Address - Fax:860-826-5626
Practice Address - Street 1:247 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052
Practice Address - Country:US
Practice Address - Phone:860-826-7597
Practice Address - Fax:860-826-5626
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036734207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G75217Medicare UPIN