Provider Demographics
NPI:1780760942
Name:JONAS, HOWARD STEPHEN (DO)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:STEPHEN
Last Name:JONAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 BRIDGEWATER CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER CORNERS
Mailing Address - State:VT
Mailing Address - Zip Code:05035-9726
Mailing Address - Country:US
Mailing Address - Phone:802-672-3875
Mailing Address - Fax:
Practice Address - Street 1:1606 BRIDGEWATER CENTER RD
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER CORNERS
Practice Address - State:VT
Practice Address - Zip Code:05035-9726
Practice Address - Country:US
Practice Address - Phone:802-672-3875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0320000234207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN0030Medicaid
B98617Medicare UPIN
VTJ0VN0030Medicare ID - Type Unspecified