Provider Demographics
NPI:1134223654
Name:SWENSON, JENNIFER P (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:P
Last Name:SWENSON
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 1:28 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3654
Mailing Address - Country:US
Mailing Address - Phone:860-358-6000
Mailing Address - Fax:
Practice Address - Street 1:1291 BOSTON POST RD STE 105
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-3476
Practice Address - Country:US
Practice Address - Phone:860-358-5100
Practice Address - Fax:860-358-8655
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037842207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0V6421OtherHEALTHNET
CTP2124502OtherOXFORD HEALTHPLANS
CT080155291OtherRAILROAD MEDICARE
CT9970741-004OtherCIGNA HEALTHCARE
CT037842OtherCONNECTICARE
CT001378422Medicaid
CT01-40510OtherUNITED HEALTHCARE
CT010037842CT01OtherANTHEM BS/BC
CT080155291OtherRAILROAD MEDICARE
CT080001338Medicare ID - Type Unspecified