Provider Demographics
NPI:1609840289
Name:POLNITSKY, CHARLES A (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:A
Last Name:POLNITSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1625 STRAITS TPKE
Mailing Address - Street 2:SUITE #201
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-1805
Mailing Address - Country:US
Mailing Address - Phone:203-573-9512
Mailing Address - Fax:203-568-2904
Practice Address - Street 1:1625 STRAITS TPKE
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-1805
Practice Address - Country:US
Practice Address - Phone:203-758-8107
Practice Address - Fax:203-568-2921
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT017430207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
E22846Medicare UPIN