Provider Demographics
NPI:1992962708
Name:RAUB, JONATHAN MATTHEW (MD, MPH, MA)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:MATTHEW
Last Name:RAUB
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Gender:M
Credentials:MD, MPH, MA
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Mailing Address - Street 1:189 STORRS RD
Mailing Address - Street 2:NATCHAUG HOSPITAL
Mailing Address - City:MANSFIELD CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06250-1683
Mailing Address - Country:US
Mailing Address - Phone:860-456-1311
Mailing Address - Fax:860-456-0164
Practice Address - Street 1:189 STORRS RD
Practice Address - Street 2:NATCHAUG HOSPITAL
Practice Address - City:MANSFIELD CENTER
Practice Address - State:CT
Practice Address - Zip Code:06250-1683
Practice Address - Country:US
Practice Address - Phone:860-456-1311
Practice Address - Fax:860-456-0164
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2022-09-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA2392562084P0800X, 2084P0804X
CT0508992084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry