Basic Information
| Provider Information | |||||||||
| NPI: | 1821063132 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JEDRAS | ||||||||
| FirstName: | BOGUMILA | ||||||||
| MiddleName: | E. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 3160 | ||||||||
| Address2: | MILFORD ANESTHESIA ASSOCIATES, P.C. | ||||||||
| City: | MILFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064609768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037831831 | ||||||||
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| Practice Location | |||||||||
| Address1: | 831 BOSTON POST ROAD | ||||||||
| Address2: | SUITE 203 MILFORD ANESTHESIA ASSOCIATES P.C. | ||||||||
| City: | MILFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037831831 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2006 | ||||||||
| LastUpdateDate: | 11/25/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 040233 | CT | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 001402338 | 05 | CT | MEDICAID |