Provider Demographics
NPI:1972896561
Name:MASTROCOLA, JENNIFER B (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:B
Last Name:MASTROCOLA
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 1:25 COLLINS RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-3893
Mailing Address - Country:US
Mailing Address - Phone:860-589-8882
Mailing Address - Fax:860-585-8898
Practice Address - Street 1:25 COLLINS RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-3893
Practice Address - Country:US
Practice Address - Phone:860-589-8882
Practice Address - Fax:860-585-8898
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT053457207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine