Provider Demographics
NPI:1699767509
Name:JEFFREY A SIMPSON MD LLC
Entity type:Organization
Organization Name:JEFFREY A SIMPSON MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-444-6868
Mailing Address - Street 1:345 MONTAUK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-4738
Mailing Address - Country:US
Mailing Address - Phone:860-444-6868
Mailing Address - Fax:860-437-0650
Practice Address - Street 1:345 MONTAUK AVE
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4738
Practice Address - Country:US
Practice Address - Phone:860-444-6868
Practice Address - Fax:860-437-0650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001146207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
50SIMPSONCT01OtherBLUE CROSS
CT00428367Medicaid
CT004248375Medicaid
C03349Medicare ID - Type Unspecified