Provider Demographics
NPI:1790860419
Name:CLOUTIER, JOSEE DIANE (MD)
Entity type:Individual
Prefix:
First Name:JOSEE
Middle Name:DIANE
Last Name:CLOUTIER
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 1:3 HIGHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NIANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06357-1808
Mailing Address - Country:US
Mailing Address - Phone:860-389-2546
Mailing Address - Fax:860-365-6961
Practice Address - Street 1:1 WAHOO AVE
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06349-2324
Practice Address - Country:US
Practice Address - Phone:860-694-1523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040820207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010040820CT02OtherANTHEM BLUE CROSS
CT9727325OtherCIGNA
CT040820OtherCONNECTICARE
CT5534978OtherFIRST HEALTH
CTP2706722OtherOXFORD
CT3581342OtherAETNA
CT134273740OtherCOMMERCIAL PLANS
CT2V4806OtherHEALTH NET
CT3581342OtherAETNA
CT080001678Medicare ID - Type UnspecifiedMEDICARE