Provider Demographics
NPI:1891988648
Name:WONG, JEAN F (MD)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:F
Last Name:WONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:455 LEWIS AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06451-2121
Mailing Address - Country:US
Mailing Address - Phone:203-238-1241
Mailing Address - Fax:203-686-0791
Practice Address - Street 1:455 LEWIS AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451-2121
Practice Address - Country:US
Practice Address - Phone:203-238-1241
Practice Address - Fax:203-686-0791
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT048139208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT048139OtherCONNECTICARE
CT06-1406459OtherUNITED HEALTHCARE
CT06-1406459OtherTRICARE
CT06-1406459OtherPIONEER
CT1891988648Medicaid
CTP4179178OtherOXFORD
CT06-1406459OtherCOMMUNITY HEALTH NETWORK
CT06-1406459OtherPRIVATE HEALTHCARE SYSTEMS
CT1891988648OtherAETNA
CT1891988648OtherANTHEM BCBS
CT57294OtherWELLCARE
CT06-1406459OtherMULTIPLAN
CT06-1406459OtherHEALTH NEW ENGLAND
CT3V6324OtherHEALTH NET
CT06-1406459OtherNORTHEAST HEALTH DIRECT
CT06-1406459OtherCORVEL
CT9048959OtherCIGNA
CT1891988648Medicaid