Provider Demographics
NPI:1659412872
Name:BRUTUS, JESSIE ME (MD)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:ME
Last Name:BRUTUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:170 FLANDERS RD STE 32
Mailing Address - Street 2:
Mailing Address - City:NIANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06357-1211
Mailing Address - Country:US
Mailing Address - Phone:860-739-7444
Mailing Address - Fax:860-739-3252
Practice Address - Street 1:170 FLANDERS RD STE 32
Practice Address - Street 2:
Practice Address - City:NIANTIC
Practice Address - State:CT
Practice Address - Zip Code:06357-1211
Practice Address - Country:US
Practice Address - Phone:860-739-7444
Practice Address - Fax:860-739-3252
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT035843208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTG31514Medicare UPIN