Provider Demographics
NPI:1083607386
Name:ZUBKOV, BELLA KACHKOFF (MD)
Entity Type:Individual
Prefix:
First Name:BELLA
Middle Name:KACHKOFF
Last Name:ZUBKOV
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 NEW LONDON TPKE
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2235
Mailing Address - Country:US
Mailing Address - Phone:860-633-1543
Mailing Address - Fax:860-659-9755
Practice Address - Street 1:210 NEW LONDON TPKE
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2235
Practice Address - Country:US
Practice Address - Phone:860-633-1543
Practice Address - Fax:860-659-9755
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035174207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT035174OtherCONNECTICARE
CT010035174CT01OtherANTHEM BC/BS
CT290564002OtherCIGNA
CT602454OtherAETNA
CT010035174CT01OtherANTHEM BC/BS