Provider Demographics
NPI:1245210913
Name:KRITZMAN, MARILYN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:
Last Name:KRITZMAN
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:PO BOX 955
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-0955
Mailing Address - Country:US
Mailing Address - Phone:860-456-6730
Mailing Address - Fax:860-456-6394
Practice Address - Street 1:112 MANSFIELD AVE
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-2041
Practice Address - Country:US
Practice Address - Phone:860-456-6730
Practice Address - Fax:860-456-6394
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035474207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001354745Medicaid
220028368Medicare PIN
CT220000495Medicare PIN
CT001354745Medicaid