Provider Demographics
NPI:1649531948
Name:HUGUENEL, BRIANA JACKSON (MD)
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:JACKSON
Last Name:HUGUENEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BRIANA
Other - Middle Name:E
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:330 WESTERN BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4383
Mailing Address - Country:US
Mailing Address - Phone:860-547-0306
Mailing Address - Fax:
Practice Address - Street 1:100 RETREAT AVE STE 700
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2553
Practice Address - Country:US
Practice Address - Phone:860-548-0885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT054954207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics