Provider Demographics
NPI:1083618532
Name:DEAN, JAMES CHRISTOPHER (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CHRISTOPHER
Last Name:DEAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1939
Mailing Address - Country:US
Mailing Address - Phone:860-928-0414
Mailing Address - Fax:860-928-2239
Practice Address - Street 1:5 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1939
Practice Address - Country:US
Practice Address - Phone:860-928-0414
Practice Address - Fax:860-928-2239
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT033374207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001333749Medicaid
CTF63493Medicare UPIN
CT001333749Medicaid
CT0641430002Medicare NSC