Provider Demographics
NPI:1942295449
Name:DICKINSON, JANET B (MD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:B
Last Name:DICKINSON
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 1:199 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06451-4024
Mailing Address - Country:US
Mailing Address - Phone:203-237-9445
Mailing Address - Fax:203-639-8734
Practice Address - Street 1:199 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451-4024
Practice Address - Country:US
Practice Address - Phone:203-237-9445
Practice Address - Fax:203-639-8734
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT024578207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
083105OtherAETNA
CT001245786Medicaid
4124110OtherAETNA
010024578CT01OtherBCBS
0V0177OtherHEALTH NET
530546OtherAETNA
724578OtherCT CARE
P2639819OtherOXFORD
P2639819OtherOXFORD
0V0177OtherHEALTH NET