Healthcare Provider Details

I. General information

NPI: 1902256704
Provider Name (Legal Business Name): JESSICA MARIE WINTERS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA MARIE CHRISTIANO M.D.

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 WASHINGTON ST
HARTFORD CT
06106-3322
US

IV. Provider business mailing address

2973 NABIL ST
BALDWINSVILLE NY
13027-9500
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-9850
  • Fax: 860-545-8812
Mailing address:
  • Phone: 315-382-8955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMT210444
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: