Provider Demographics
NPI:1376520858
Name:LEWINTER, JODY R (MD)
Entity Type:Individual
Prefix:DR
First Name:JODY
Middle Name:R
Last Name:LEWINTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:336 NORTH MAIN STREET
Mailing Address - Street 2:HARTFORD MEDICAL GROUP
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-0186
Mailing Address - Country:US
Mailing Address - Phone:860-232-4891
Mailing Address - Fax:860-236-1016
Practice Address - Street 1:336 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117
Practice Address - Country:US
Practice Address - Phone:860-232-4891
Practice Address - Fax:860-263-1016
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT030729207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001307299Medicaid
E16875Medicare UPIN
CT001307299Medicaid
CT930000259Medicare PIN