Provider Demographics
NPI:1619934296
Name:JONES, PETER DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:DAVID
Last Name:JONES
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 1:14 QUARRY ST
Mailing Address - Street 2:
Mailing Address - City:WILLIMANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06226-1232
Mailing Address - Country:US
Mailing Address - Phone:860-423-8020
Mailing Address - Fax:860-456-8288
Practice Address - Street 1:14 QUARRY ST
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-1232
Practice Address - Country:US
Practice Address - Phone:860-423-8020
Practice Address - Fax:860-456-8288
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT019026207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00119026300OtherBLUECARE FAMILY PLAN
CT782359OtherCONNECTICARE
CT030188OtherHEALTHNET OF THE NE
CTWIP002OtherOXFORD HEALTH PLAN
CT001190263Medicaid
CT010019026CT01OtherANTHEM BC/BS
CTWIP002OtherOXFORD HEALTH PLAN
CT001190263Medicaid