Provider Demographics
NPI:1164488094
Name:SAPOZHNIKOV, EUGENE (MD)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:
Last Name:SAPOZHNIKOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:EUGENE
Other - Middle Name:
Other - Last Name:SAPOZHNIKOV
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:234A BANK STREET 4TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-6054
Mailing Address - Country:US
Mailing Address - Phone:860-442-0290
Mailing Address - Fax:860-442-2136
Practice Address - Street 1:234A BANK ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-6054
Practice Address - Country:US
Practice Address - Phone:860-442-0290
Practice Address - Fax:860-442-2136
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038561207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001385617Medicaid
CT010038561CT01OtherBLUE CROSS
CT010038561CT01OtherBLUE CROSS
CT001385617Medicaid