Provider Demographics
NPI:1205885258
Name:GAUDIO, JON C (MD)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:C
Last Name:GAUDIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:481 GOLD STAR HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-6224
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:196 PARKWAY SOUTH
Practice Address - Street 2:SUITE 103
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385
Practice Address - Country:US
Practice Address - Phone:860-443-4383
Practice Address - Fax:860-448-6797
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT40569207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
06-1616101OtherUNITEDHEALTHCARE/ECCD
06-1616101OtherCOMM. HEALTH NETWORK/ECCD
010040569CT01OtherANTHEM/ECCG:06-1049086
P2680050OtherOXFORD/ECCG: 06-1049086
010040569CT03OtherANTHEM/ECCD:06-1616101
2V2262OtherHEALTHNET/ECCD:06-1616101
040569OtherCONNECTICARE
06-1049086OtherCOMM. HEALTH NETWORK/ECCG
06-1049086OtherUNITEDHEALTHCARE/ECCG
060070007OtherRR MED/ECCD: 06-1616101
P3615266OtherOXFORD/ECCD: 06-1616101
CT001405697Medicaid
060069422OtherRR MED/ECCG: 06-1049086
001405697OtherBLUECARE FAMILY PLAN
2V2256OtherHEALTHNET/ECCG:06-1049086
500HBC444CT01OtherANTHEM/HOSP-BASED ECCD
010040569CT01OtherANTHEM/ECCG:06-1049086
06-1049086OtherCOMM. HEALTH NETWORK/ECCG
06-1616101OtherUNITEDHEALTHCARE/ECCD