Provider Demographics
NPI:1215966619
Name:OUELLETTE, JASON R (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:R
Last Name:OUELLETTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:56 FRANKLIN ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06706-1221
Mailing Address - Country:US
Mailing Address - Phone:203-709-8873
Mailing Address - Fax:203-709-8689
Practice Address - Street 1:56 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06706-1221
Practice Address - Country:US
Practice Address - Phone:203-709-8828
Practice Address - Fax:203-709-3518
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042496207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT3679667/7030649OtherAETNA
CT959905OtherUSA
CTPENDINGOtherRR MEDICARE
CT001424960Medicaid
CT2V5800OtherHEALTHNET/COMMERCIAL
CT010042496CT01OtherANTHEM BCBS CT
CT368650OtherWELLCARE
CT042496OtherCONNECTICARE
CTP3408258OtherOXFORD
CT24-50636OtherAMERICHOICE
CT24-50636OtherUHC
CT959905OtherUSA
CTI16290Medicare UPIN