Healthcare Provider Details

I. General information

NPI: 1073711776
Provider Name (Legal Business Name): JASON MAYO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LIBERTY SQ
NEW BRITAIN CT
06051-2637
US

IV. Provider business mailing address

1 LIBERTY SQ P.O. BOX 217
NEW BRITAIN CT
06051-2637
US

V. Phone/Fax

Practice location:
  • Phone: 860-827-0071
  • Fax: 860-229-5642
Mailing address:
  • Phone: 860-827-0071
  • Fax: 860-229-5642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number49644
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: