DEREK POULIN (Credential# 1511721) is licensed (Resident Physician) with Connecticut Department of Consumer Protection. The license effective date is July 1, 2018. The license expiration date date is June 30, 2021. The license status is ACTIVE.
DEREK POULIN is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.060652-RES. The credential type is resident physician. The effective date is July 1, 2018. The expiration date is June 30, 2021. The business address is 263 Farmington Avenue, Farmington, CT 06030-1921. The current status is active.
| Licensee Name | DEREK POULIN |
| Credential ID | 1511721 |
| Credential Number | 1.060652-RES |
| Credential Type | Resident Physician |
| Credential SubCategory | RES |
| Business Address |
263 Farmington Avenue Farmington CT 06030-1921 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2018-07-01 |
| Effective Date | 2018-07-01 |
| Expiration Date | 2021-06-30 |
| Refresh Date | 2018-05-07 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1519208 | CSP.0068451 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2018-05-31 | 2019-03-01 - 2021-02-28 | ACTIVE |
| Street Address | 263 Farmington Avenue |
| City | Farmington |
| State | CT |
| Zip Code | 06030-1921 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Davis Aasen | 263 Farmington Avenue, Farmington, CT 06030-1921 | Resident Physician | 2020-07-01 ~ 2025-06-30 |
| Christopher D Lemoine | 263 Farmington Avenue, Farmington, CT 06030-1921 | Resident Physician | 2020-07-01 ~ 2025-06-30 |
| Dylan Buller | 263 Farmington Avenue, Farmington, CT 06030-1921 | Resident Physician | 2020-07-01 ~ 2025-06-30 |
| Jennifer Lindelof | 263 Farmington Avenue, Farmington, CT 06030-1921 | Resident Physician | 2020-07-01 ~ 2025-06-30 |
| Colin J Pavano | 263 Farmington Avenue, Farmington, CT 06030-1921 | Resident Physician | 2020-07-01 ~ 2025-06-30 |
| Barrett B Torre | 263 Farmington Avenue, Farmington, CT 06030-1921 | Resident Physician | 2020-07-01 ~ 2025-06-30 |
| Samantha Slattery | 263 Farmington Avenue, Farmington, CT 06030-1921 | Resident Physician | 2020-07-01 ~ 2025-06-30 |
| Ethan A Miller | 263 Farmington Avenue, Farmington, CT 06030-1921 | Resident Physician | 2020-06-28 ~ 2024-06-30 |
| Patrick Bergamo | 263 Farmington Avenue, Farmington, CT 06030-1921 | Resident Physician | 2020-06-28 ~ 2024-06-30 |
| Shriya Gupta | 263 Farmington Avenue, Farmington, CT 06030-1921 | Resident Physician | 2020-06-28 ~ 2024-06-30 |
| Find all Licenses in the same address | |||
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Hady Eltayeby | 263 Farmington Avenue, Ct, Farmington, CT 06030-1921 | Controlled Substance Registration for Practitioner | ~ |
| Hassaan Aftab | 263 Farmington Ave, Farmington, CT 06030-1921 | Resident Physician | 2019-07-01 ~ 2021-06-30 |
| Adriana Kahn | 263 Farmington Ave, Farmington, CT 06030-1921 | Resident Physician | 2018-06-28 ~ 2021-06-30 |
| Shinya U. Amano | 263 Farmington Ave, Farmington, CT 06030-1921 | Resident Physician | 2019-05-23 ~ 2019-06-06 |
| Mathur Prateek | 263 Farmington Ave, Farmington, CT 06030-1921 | Resident Physician | 2019-01-02 ~ 2019-01-24 |
| Kenneth Aguirre | 263 Farmington Ave, Farmington, CT 06030-1921 | Resident Physician | 2018-11-08 ~ 2018-11-17 |
| Nick M Feo | 263 Farmington Ave, Farmington, CT 06030-1921 | Resident Physician | 2018-10-01 ~ 2018-10-14 |
| Rabeea Nazir | 263 Farmington Ave, Farmington, CT 06030-1921 | Resident Physician | 2018-09-30 ~ 2018-10-13 |
| Jacob Jabbour | 263 Farmington Ave, Farmington, CT 06030-1921 | Resident Physician | 2018-09-17 ~ 2018-09-28 |
| Natalie Godfrey | 263 Farmington Ave, Farmington, CT 06030-1921 | Resident Physician | 2018-08-13 ~ 2018-08-24 |
| Find all Licenses in zip 06030-1921 | |||
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Eric Anthony Brueckner | 263 Farmington Ave., Farmington, CT 06030 | Physician/surgeon | 2020-08-01 ~ 2021-07-31 |
| Derrick B Bremang | Residency Program, Farmington, CT 06030 | Physician/surgeon | 2020-06-01 ~ 2021-06-30 |
| David M Shafer | Uconn Health Center, Farmington, CT 06030 | Dentist | 2020-07-01 ~ 2021-06-30 |
| Michael J Murphy | Dept of Dermatology, Farmington, CT 06030 | Physician/surgeon | 2020-09-01 ~ 2021-08-31 |
| Richard F Kaplan | Univ. of Ct., Farmington, CT 06030 | Psychologist | 2020-06-01 ~ 2021-05-31 |
| Nicholas George Vitale | 22 Woods Drive, Norwich, CT 06030 | Casino Class I Employee | 2019-12-03 ~ 2020-10-31 |
| Bruce E Gould | Univ of Conn Health Center, Farmington, CT 06030 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
| Vinayak M Sathe | Uconn Health Center,263 Farmington Ave, Farmington, CT 06030 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Shobhana Pathani | Department of Medicine, 263 Farmington Ave, CT 06030 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Patricia L Almeida | John Dempsey Hospital, Farmington, CT 06030 | Registered Nurse | 2020-04-01 ~ 2021-03-31 |
| Find all Licenses in zip 06030 | |||
| City | Farmington |
| Zip Code | 06030 |
| License Type | Resident Physician |
| License Type + County | Resident Physician + Farmington |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Derek Lee | 90 S Main St, Middletown, CT 06457-3649 | Resident Physician | 2018-06-25 ~ 2022-07-03 |
| Derek Scherbel | 20 York St, New Haven, CT 06510 | Resident Physician | 2020-06-24 ~ 2021-06-30 |
| Derek O Udeh | 20 York St, New Haven, CT 06510 | Resident Physician | 2020-06-11 ~ 2021-06-30 |
| Derek Biederman | 1245 Park Ave Apt 6h, New York, NY 10128-1737 | Resident Physician | 2017-07-10 ~ 2019-06-30 |
| Gerald Poulin | 350 Prospect St, Suffield, CT 06078 | Home Improvement Contractor | 1999-12-01 ~ 2000-11-30 |
| Michael J Poulin · M Poulin Decorative Pntng & Stnng | 15 Martin Terrace, Ansonia, CT 06401 | Home Improvement Contractor | 2012-03-07 ~ 2012-11-30 |
| Marc A Poulin · Marc Poulin Construction | 83 Serpentine Rd, Bridgeport, CT 06606 | Home Improvement Contractor | 2005-12-01 ~ 2006-11-30 |
| Guy Poulin · Guy Poulin Carpentry | 38 Gregory St, Danbury, CT 06811-4432 | Home Improvement Contractor | 2018-12-01 ~ 2019-11-30 |
| Florent Poulin · Poulin Contractors | 87 E Woods Rd, Roxbury, CT 06783-1917 | Home Improvement Contractor | 2013-12-01 ~ 2014-11-30 |
| James T Poulin · J Poulin Construction | 430 Strong Rd, South Windsor, CT 06074 | Home Improvement Contractor | 2019-12-01 ~ 2020-11-30 |
Please comment or provide details below to improve the information on DEREK POULIN.
| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).