Provider Demographics
NPI:1336280007
Name:PALKER, NEIL A (MD)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:A
Last Name:PALKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 FLANDERS RD
Mailing Address - Street 2:
Mailing Address - City:NIANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06357-1264
Mailing Address - Country:US
Mailing Address - Phone:860-739-5426
Mailing Address - Fax:860-739-0063
Practice Address - Street 1:248 FLANDERS RD
Practice Address - Street 2:
Practice Address - City:NIANTIC
Practice Address - State:CT
Practice Address - Zip Code:06357-1264
Practice Address - Country:US
Practice Address - Phone:860-739-5426
Practice Address - Fax:860-739-0063
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT017519207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001175199Medicaid
CT110006023Medicare ID - Type Unspecified
CT001175199Medicaid