Provider Demographics
NPI:1437168457
Name:WARADZIN, MARLENE L (MD)
Entity Type:Individual
Prefix:DR
First Name:MARLENE
Middle Name:L
Last Name:WARADZIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:185 CENTER ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-4100
Mailing Address - Country:US
Mailing Address - Phone:203-284-1060
Mailing Address - Fax:203-284-4981
Practice Address - Street 1:185 CENTER ST
Practice Address - Street 2:SUITE H
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-4100
Practice Address - Country:US
Practice Address - Phone:203-284-1060
Practice Address - Fax:203-284-4981
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT031062207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001310622Medicaid
CT001310622Medicaid
CTF36466Medicare UPIN