Provider Demographics
NPI:1609835735
Name:TESTA, JOHN A (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:TESTA
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 1:166 WATERBURY RD
Mailing Address - Street 2:STE 300
Mailing Address - City:PROSPECT
Mailing Address - State:CT
Mailing Address - Zip Code:06712
Mailing Address - Country:US
Mailing Address - Phone:203-758-0878
Mailing Address - Fax:203-758-0877
Practice Address - Street 1:166 WATERBURY RD
Practice Address - Street 2:STE 300
Practice Address - City:PROSPECT
Practice Address - State:CT
Practice Address - Zip Code:06712
Practice Address - Country:US
Practice Address - Phone:203-758-0878
Practice Address - Fax:203-758-0877
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040224207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT3V0866OtherHEALTHNET/COMMERCIAL
CT010040224CT03OtherANTHEM BCBS CT
CT276436OtherWELLCARE
CTP01047925OtherRR MEDICARE
CTP3945105OtherOXFORD
CT02208443OtherUHC
CT040224OtherCONNECTICARE
CT1402247Medicaid
CT7853384OtherAETNA
CTP3945105OtherOXFORD
CT1402247Medicaid
CT7853384OtherAETNA