Provider Demographics
NPI:1558355792
Name:PIEKARSKY, MARK A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:PIEKARSKY
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 1:300 KENSINGTON AVE
Mailing Address - Street 2:GROVE HILL MEDICAL CENTER
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-3916
Mailing Address - Country:US
Mailing Address - Phone:860-832-8150
Mailing Address - Fax:860-224-6953
Practice Address - Street 1:300 KENSINGTON AVE
Practice Address - Street 2:GROVE HILL MEDICAL CENTER
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-3916
Practice Address - Country:US
Practice Address - Phone:860-832-8150
Practice Address - Fax:860-224-6953
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037646207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001376468Medicaid
CT0V5029OtherHEALTH NET
CTP1291497OtherOXFORD
CT004215324Medicaid
CT110188282OtherRAIL ROAD MEDICARE ID
CT010037646CT01OtherBCBS & BCFP PROV ID
CT334265OtherWELLCARE MEDICARE
CT01037646OtherCIGNA
CT1255448155OtherGHMC GROUP NPI
CT037646OtherCONNECTICARE
CT2190286OtherAETNA
CTP1291497OtherOXFORD
CT110188282OtherRAIL ROAD MEDICARE ID
CT004215324Medicaid