Provider Demographics
NPI:1306821863
Name:BREITER, JEFFREY ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ROBERT
Last Name:BREITER
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 1:2139 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-2336
Mailing Address - Country:US
Mailing Address - Phone:860-257-4131
Mailing Address - Fax:860-257-4519
Practice Address - Street 1:2400 TAMARACK AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-5539
Practice Address - Country:US
Practice Address - Phone:860-644-4442
Practice Address - Fax:860-644-1412
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT021746207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001217462Medicaid
CT010021746CT01OtherBLUE CROSS BLUE SHIELD
CTHAS731OtherOXFORD HEALTHCARE
CT054626OtherCONNECTICARE
CT0V8025OtherHEALTHNET
CT543542OtherAETNA
CT054626OtherCONNECTICARE
CT010021746CT01OtherBLUE CROSS BLUE SHIELD