Provider Demographics
NPI:1073567772
Name:TONNESSEN, BRITT H (MD)
Entity Type:Individual
Prefix:DR
First Name:BRITT
Middle Name:H
Last Name:TONNESSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 CEDAR STREET, BOARDMAN 204
Mailing Address - Street 2:P.O. BOX 208062
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520-8062
Mailing Address - Country:US
Mailing Address - Phone:203-785-6258
Mailing Address - Fax:203-785-7556
Practice Address - Street 1:330 CEDAR STREET, BOARDMAN 204
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06520-8062
Practice Address - Country:US
Practice Address - Phone:203-785-6258
Practice Address - Fax:203-785-7556
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL328822086S0129X
SC328822086S0129X
CT622762086S0129X
NY2822892086S0129X
LAMD.0255292086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC328826Medicaid
SCP00883534OtherRR MEDICARE ID RSFP
SCP00883534OtherRR MEDICARE ID RSFP
SCAA56909223Medicare PIN
I19577Medicare UPIN
LA4J128Medicare ID - Type Unspecified