Provider Demographics
NPI:1700020377
Name:NEUBAUER, MARTA MIECZKOWSKA (MD)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:MIECZKOWSKA
Last Name:NEUBAUER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARTA
Other - Middle Name:
Other - Last Name:MIECZKOWSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:282 WASHINGTON ST
Mailing Address - Street 2:HARTFORD
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-3322
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:282 WASHINGTON ST
Practice Address - Street 2:HARTFORD
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-3322
Practice Address - Country:US
Practice Address - Phone:860-545-8954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT050810208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics