Provider Demographics
NPI:1205010493
Name:SICO, JASON JONATHON (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:JONATHON
Last Name:SICO
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 1:78 COVE ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-4304
Mailing Address - Country:US
Mailing Address - Phone:203-988-7553
Mailing Address - Fax:203-688-1322
Practice Address - Street 1:78 COVE ST UNIT 1
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06512-4304
Practice Address - Country:US
Practice Address - Phone:203-988-7553
Practice Address - Fax:203-688-1322
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease