Provider Demographics
NPI:1821063132
Name:JEDRAS, BOGUMILA E (MD)
Entity Type:Individual
Prefix:DR
First Name:BOGUMILA
Middle Name:E
Last Name:JEDRAS
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:P.O. BOX 3160
Mailing Address - Street 2:MILFORD ANESTHESIA ASSOCIATES, P.C.
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-9768
Mailing Address - Country:US
Mailing Address - Phone:203-783-1831
Mailing Address - Fax:
Practice Address - Street 1:831 BOSTON POST ROAD
Practice Address - Street 2:SUITE 203 MILFORD ANESTHESIA ASSOCIATES P.C.
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460
Practice Address - Country:US
Practice Address - Phone:203-783-1831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040233207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001402338Medicaid
CT001402338Medicaid
050001289Medicare ID - Type Unspecified