Dr. Maria Mikolaenko
Family Doctor - Adult Medicine
2979 Main St
Bridgeport
, Connecticut 06606-4284
Dr. Maria Mikolaenko
Family Doctor - Adult Medicine
2979 Main St
Bridgeport
, Connecticut 06606-4284
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About
Features
Specialties
- Family Doctor - Adult Medicine
Languages spoken
- English
Location
First Address
- Dr. Maria Mikolaenko
- 1290 Silas Deane Hwy
- Wethersfield, CT
- Zip : 06109-4337
- Phone :
Second Address
- Dr. Maria Mikolaenko
- 2979 Main St
- Bridgeport, CT
- Zip : 06606-4284
- Fax : (203) 366-0868
- Phone : (203) 382-2345
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207QA0505X | Family Doctor - Adult Medicine | 66720 | CT |
| N | 207QA0505X | Family Doctor - Adult Medicine | OS15147 | FL |
National Provider Identifier
| NPI | 1063824761 |
|---|---|
| Provider Name | Dr. Maria Mikolaenko |
| First Address | Wethersfield, CT 06109-4337 |
| Second Address | Bridgeport, CT 06606-4284 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 29/05/2014 |
| Last Update Date | 02/10/2020 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| OS15147 | STATE LICENSE (01) | FL |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.