Provider Demographics
NPI:1023174745
Name:HENRY, JEAN GUINESS (MD)
Entity type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:GUINESS
Last Name:HENRY
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 1:6 BUSINESS PARK DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-2988
Mailing Address - Country:US
Mailing Address - Phone:203-488-5885
Mailing Address - Fax:203-488-5889
Practice Address - Street 1:6 BUSINESS PARK DR
Practice Address - Street 2:SUITE 304
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-2988
Practice Address - Country:US
Practice Address - Phone:203-488-5885
Practice Address - Fax:203-488-5889
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT033820174400000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTF88175Medicare UPIN