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General NPI Number Information
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NPI Number | 1396795951
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Entity Type | Organization
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Legal Business Name | JEFFERSON RADIOLOGY, PC
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 85 SEYMOUR ST STE 200
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City | HARTFORD
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State | CT
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Zip | 06106-5509
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Country | US
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Telephone | 860-289-3375
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Fax | 860-783-5733
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Provider Business Mailing Address
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Address Line | 55 HARTLAND ST SUITE 200
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City | EAST HARTFORD
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State | CT
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Zip | 06108-3244
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Country | US
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Telephone | 860-528-2080
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Fax | 860-291-6594
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | SHARLEE LEBLEU
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Credential |
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Telephone | 480-321-7026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207U00000X
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Taxonomy Name | Nuclear Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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