Provider Demographics
NPI:1801015854
Name:MARCOUS, KRISTIN J (PA)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:J
Last Name:MARCOUS
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:2139 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-2336
Mailing Address - Country:US
Mailing Address - Phone:860-257-4131
Mailing Address - Fax:860-257-4519
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:SUITE 1000
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-246-2571
Practice Address - Fax:860-246-3691
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2011-04-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT001821207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT970002469Medicare PIN