Provider Demographics
NPI:1750607362
Name:GJEDE, JESSICA M (MD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:M
Last Name:GJEDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:30 HOFFMANN RD.
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:CT
Mailing Address - Zip Code:06019
Mailing Address - Country:US
Mailing Address - Phone:860-830-4714
Mailing Address - Fax:860-348-4646
Practice Address - Street 1:1111 CROMWELL AVE.
Practice Address - Street 2:SUITE 202
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067
Practice Address - Country:US
Practice Address - Phone:860-348-4242
Practice Address - Fax:860-348-4646
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2019-06-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT052822207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA244492OtherMASSACHUSETTS MEDICAL LICENSE