Provider Demographics
NPI:1407053655
Name:OLLENSCHLEGER, MARTIN D (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:D
Last Name:OLLENSCHLEGER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:85 SEYMOUR ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5501
Mailing Address - Country:US
Mailing Address - Phone:860-293-6053
Mailing Address - Fax:860-293-6060
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:SUITE 200
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-293-6053
Practice Address - Fax:860-293-6060
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2011-09-15
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Provider Licenses
StateLicense IDTaxonomies
NY2340672085N0700X, 2084N0400X, 2085R0202X
CT488922084N0400X, 2085N0700X, 2085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03103495Medicaid