Healthcare Provider Details

I. General information

NPI: 1649382839
Provider Name (Legal Business Name): JONATHAN A DIXON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEYMOUR STREET HARTFORD HOSPITAL RHEUMATOLOGY SERVICES
HARTFORD CT
06102-5037
US

IV. Provider business mailing address

PO BOX 415933 HARTFORD HOSPITAL PROFESSIONAL SERVICES
BOSTON MA
02241-5933
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-3667
  • Fax:
Mailing address:
  • Phone: 860-545-7602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number021512
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: