Provider Demographics
NPI:1720089881
Name:HENCHEL, JACQUELINE K (MD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:K
Last Name:HENCHEL
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 1:874 HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1106
Mailing Address - Country:US
Mailing Address - Phone:203-688-8200
Mailing Address - Fax:203-688-8204
Practice Address - Street 1:874 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1106
Practice Address - Country:US
Practice Address - Phone:203-688-8200
Practice Address - Fax:203-688-8204
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT014731207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT061561581OtherCIGNA
CT0Q2382OtherHEALTH NET
CT180747OtherWELLCARE OF CT
CT714531OtherCONNECTICARE
CT001147314Medicaid
CT061561581OtherHEALTH CT
CT110196702OtherRAIL ROAD MEDICARE
CT2026136OtherAETNA
CT010014731CT03OtherANTHEM BC/BS
CT061561581OtherUNITED HEALTHCARE
CTP488325OtherOXFORD
CT001147314Medicaid
CT061561581OtherUNITED HEALTHCARE