Basic Information
| Provider Information | |||||||||
| NPI: | 1225261563 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAEGER | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 114 WOODLAND ST | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061051208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607146654 | ||||||||
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| Practice Location | |||||||||
| Address1: | 114 WOODLAND ST | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061051208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607146654 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2009 | ||||||||
| LastUpdateDate: | 12/17/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/17/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 013441-1 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207L00000X | 57090 | CT | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.