Provider Demographics
NPI:1902919335
Name:JENSEN, JERRI (MD)
Entity type:Individual
Prefix:DR
First Name:JERRI
Middle Name:
Last Name:JENSEN
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 1:69 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-5325
Mailing Address - Country:US
Mailing Address - Phone:844-359-8363
Mailing Address - Fax:833-929-3520
Practice Address - Street 1:69 GROVE ST
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-5325
Practice Address - Country:US
Practice Address - Phone:844-359-8363
Practice Address - Fax:833-929-3520
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD13248207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME4254797OtherAETNA
ME3342110OtherAETNA
ME123990099Medicaid
MEAA84099OtherHARVARD PILGRIM HEALTH CARE
MEP00050169OtherRAILROAD MEDICARE
ME046539OtherBCBS
MEMM4085Medicare PIN
ME3342110OtherAETNA
ME123990099Medicaid