Provider Demographics
NPI:1679572150
Name:SAWULA, BORIS J (MD)
Entity Type:Individual
Prefix:MR
First Name:BORIS
Middle Name:J
Last Name:SAWULA
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 1:538 LITCHFIELD ST
Mailing Address - Street 2:STE 202
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-6669
Mailing Address - Country:US
Mailing Address - Phone:860-489-1038
Mailing Address - Fax:860-496-4094
Practice Address - Street 1:538 LITCHFIELD ST
Practice Address - Street 2:STE 202
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6669
Practice Address - Country:US
Practice Address - Phone:860-489-1038
Practice Address - Fax:860-496-4094
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT24654207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004159605Medicaid
B39271Medicare UPIN
CT004159605Medicaid