Provider Demographics
NPI:1295479426
Name:KAUSHAL, JESSICA (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:KAUSHAL
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 1:267 GRANT STREET, MEDICAL EDUCATION PODIUM 4
Mailing Address - Street 2:BRIDGEPORT, CT, 06610, USA
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610
Mailing Address - Country:US
Mailing Address - Phone:203-384-3000
Mailing Address - Fax:203-384-4680
Practice Address - Street 1:267 GRANT STREET, MEDICAL EDUCATION PODIUM 4
Practice Address - Street 2:BRIDGEPORT, CT, 06610, USA
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610
Practice Address - Country:US
Practice Address - Phone:203-384-3000
Practice Address - Fax:203-384-4680
Is Sole Proprietor?:No
Enumeration Date:2022-04-25
Last Update Date:2023-02-20
Deactivation Date:2023-01-27
Deactivation Code:
Reactivation Date:2023-02-20
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program