Provider Demographics
NPI:1376692160
Name:HARWIN, JONATHAN ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ERIC
Last Name:HARWIN
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 1:682 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-2907
Mailing Address - Country:US
Mailing Address - Phone:203-481-5591
Mailing Address - Fax:203-481-5594
Practice Address - Street 1:682 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-2907
Practice Address - Country:US
Practice Address - Phone:203-481-5591
Practice Address - Fax:203-481-5594
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035287208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
COH81204Medicare UPIN