Provider Demographics
NPI:1073703815
Name:EUGENE, MARIE CARL (DO)
Entity Type:Individual
Prefix:
First Name:MARIE CARL
Middle Name:
Last Name:EUGENE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 FARMINGTON AVE
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-2212
Mailing Address - Country:US
Mailing Address - Phone:860-679-4888
Mailing Address - Fax:860-679-0131
Practice Address - Street 1:263 FARMINGTON AVE
Practice Address - Street 2:NEUROLOGY MC-3835
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-3835
Practice Address - Country:US
Practice Address - Phone:860-679-4888
Practice Address - Fax:860-679-1042
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0493372084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1073703815Medicaid