Provider Demographics
NPI:1205827342
Name:WALDEN, JEFFREY H (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:H
Last Name:WALDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:305 WESTERN BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4380
Mailing Address - Country:US
Mailing Address - Phone:860-522-0604
Mailing Address - Fax:860-522-1761
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:SUITE 719
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-522-0604
Practice Address - Fax:860-522-1761
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2015-05-20
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Provider Licenses
StateLicense IDTaxonomies
CT039333207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060001459OtherMCPIN CT HEART PHYSICIANS
CTCA7937OtherRAILROAD MEDICARE GROUP #
CTC00585OtherPTAN CONS. CARDIOLOGISTS
CT001393339Medicaid
CT010039333CT01OtherANTHEM BCBS
CT060066461OtherRAILROAD MEDICARE
060876456OtherEIN
CT060001403Medicare PIN
CT060001459Medicare PIN
CT001393339Medicaid