Provider Demographics
NPI:1508203316
Name:VOLKIN, DMITRY (MD)
Entity Type:Individual
Prefix:
First Name:DMITRY
Middle Name:
Last Name:VOLKIN
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 1:5 DAYTON RD STE 202
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-4205
Mailing Address - Country:US
Mailing Address - Phone:860-886-1956
Mailing Address - Fax:
Practice Address - Street 1:5 DAYTON RD STE 202
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-4205
Practice Address - Country:US
Practice Address - Phone:860-886-1956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT603862088F0040X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No2088F0040XAllopathic & Osteopathic PhysiciansUrologyFemale Pelvic Medicine and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010060386CT01OtherANTHEM BLUE CROSS BLUE SHIELD