Provider Demographics
NPI:1568464212
Name:PENDLETON, JONATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:PENDLETON
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 1:300 KENSINGTON AVE
Mailing Address - Street 2:GROVE HILL MEDICAL CENTER
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-3916
Mailing Address - Country:US
Mailing Address - Phone:860-747-5766
Mailing Address - Fax:860-747-2028
Practice Address - Street 1:184 EAST ST
Practice Address - Street 2:GROVE HILL MEDICAL CENTER
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-2913
Practice Address - Country:US
Practice Address - Phone:860-747-5766
Practice Address - Fax:860-747-2028
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT022201207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP369805OtherOXFORD
CT004215324Medicaid
CT1255448155OtherGHMC GROUP NPI ID
CT135678OtherWELLCARE MEDICARE
CT5978401OtherCONNECTICARE
CT010022201CT01OtherBCBS & BCFP ID
CT060031OtherHEALTH NET
CT110116250OtherRAIL ROAD MEDICARE ID
CT477354OtherAETNA
CT001222017Medicaid
CT01022201OtherCIGNA
CT060031OtherHEALTH NET
B39647Medicare UPIN
CT110000999Medicare ID - Type Unspecified