Provider Demographics
NPI:1326120577
Name:TURCOTTE, JAN K (MD)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:K
Last Name:TURCOTTE
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 1:428 WASHINGTON ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-3736
Mailing Address - Country:US
Mailing Address - Phone:315-788-2400
Mailing Address - Fax:315-788-3660
Practice Address - Street 1:428 WASHINGTON ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-3736
Practice Address - Country:US
Practice Address - Phone:315-788-2400
Practice Address - Fax:315-788-3660
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143676208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00682602Medicaid
NY34682AMedicare ID - Type UnspecifiedMEDICARE
NY00682602Medicaid
NY34682FMedicare PIN