Provider Demographics
NPI:1982706990
Name:POPELESKI, LAURA C (PAC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:C
Last Name:POPELESKI
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:112 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2737
Mailing Address - Country:US
Mailing Address - Phone:860-425-8701
Mailing Address - Fax:860-425-8707
Practice Address - Street 1:163 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06415-1022
Practice Address - Country:US
Practice Address - Phone:860-537-4601
Practice Address - Fax:860-537-6935
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT001426363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q09720Medicare UPIN