Provider Demographics
NPI:1790860419
Name:CLOUTIER, JOSEE DIANE (MD)
Entity Type:Individual
Prefix:
First Name:JOSEE
Middle Name:DIANE
Last Name:CLOUTIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 LIBERTY WAY
Mailing Address - Street 2:SUITE 10B
Mailing Address - City:NIANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06357-1032
Mailing Address - Country:US
Mailing Address - Phone:860-691-8084
Mailing Address - Fax:860-691-1195
Practice Address - Street 1:10 LIBERTY WAY
Practice Address - Street 2:SUITE 10B
Practice Address - City:NIANTIC
Practice Address - State:CT
Practice Address - Zip Code:06357-1032
Practice Address - Country:US
Practice Address - Phone:860-691-8084
Practice Address - Fax:860-691-1195
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040820207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010040820CT02OtherANTHEM BLUE CROSS
CT9727325OtherCIGNA
CTP2706722OtherOXFORD
CT2V4806OtherHEALTH NET
CT3581342OtherAETNA
CT5534978OtherFIRST HEALTH
CT134273740OtherCOMMERCIAL PLANS
CT040820OtherCONNECTICARE
CT3581342OtherAETNA
CT080001678Medicare ID - Type UnspecifiedMEDICARE