Healthcare Provider Details

I. General information

NPI: 1245920701
Provider Name (Legal Business Name): JEREMY DOUCETTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 MAIN ST
BRANFORD CT
06405-3730
US

IV. Provider business mailing address

960 MAIN ST
BRANFORD CT
06405-3730
US

V. Phone/Fax

Practice location:
  • Phone: 203-488-6358
  • Fax: 203-481-5327
Mailing address:
  • Phone: 203-488-6358
  • Fax: 203-481-5327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number84130
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: