Provider Demographics
NPI:1992868434
Name:TELSEY, JONATHAN I (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:I
Last Name:TELSEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 WASHINGTON ST STE 350
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2700
Mailing Address - Country:US
Mailing Address - Phone:860-886-1956
Mailing Address - Fax:
Practice Address - Street 1:330 WASHINGTON ST STE 350
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360
Practice Address - Country:US
Practice Address - Phone:860-886-1956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT61956208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEUX3504Medicare PIN
MEMM068502Medicare PIN
MEH73265Medicare UPIN
MEME0685Medicare PIN