Provider Demographics
NPI:1639338858
Name:COICULESCU, OLIVIA ELENA (MD)
Entity type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:ELENA
Last Name:COICULESCU
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 1:194 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-5544
Mailing Address - Country:US
Mailing Address - Phone:860-444-3366
Mailing Address - Fax:860-447-2542
Practice Address - Street 1:194 HOWARD ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-5544
Practice Address - Country:US
Practice Address - Phone:860-444-3366
Practice Address - Fax:860-447-2542
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT507972084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT50797OtherCT LICENSE
KY000000617149OtherANTHEM
KY42396OtherKY STATE LICENSE
KY7100107720Medicaid
KY7100107720Medicaid
KY000000617149OtherANTHEM