Provider Demographics
NPI:1760581441
Name:KOWALSKA-BERGER, MALGORZATA (MD)
Entity Type:Individual
Prefix:
First Name:MALGORZATA
Middle Name:
Last Name:KOWALSKA-BERGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 HART ST
Mailing Address - Street 2:DOOR C
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052
Mailing Address - Country:US
Mailing Address - Phone:860-223-6989
Mailing Address - Fax:860-223-2947
Practice Address - Street 1:40 HART ST
Practice Address - Street 2:DOOR C
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052
Practice Address - Country:US
Practice Address - Phone:860-223-6989
Practice Address - Fax:860-223-2947
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT022819207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010022819CT01OtherANTHEM BS
CT050042OtherCT CARE
CT2V2544OtherHEALTHNET
CT01022819OtherCIGNA
CT022818OtherLICENSE
CT2172975OtherAETNA
CT010022819CT01OtherANTHEM BS