Provider Demographics
NPI:1093151854
Name:BELNIAK, MARY HOCTOR (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:HOCTOR
Last Name:BELNIAK
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 1:540 SAYBROOK RD STE 360
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4745
Mailing Address - Country:US
Mailing Address - Phone:860-347-7491
Mailing Address - Fax:
Practice Address - Street 1:540 SAYBROOK RD STE 360
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4745
Practice Address - Country:US
Practice Address - Phone:860-347-7491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60776521207V00000X
390200000X
CT072995207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program