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NPI Code Detail

MEDICARE: DR. JOHN JOSEPH HENNESSEY M.D.

MEDICARE: DR. JOHN JOSEPH HENNESSEY M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician037592CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215916564
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN JOSEPH HENNESSEY M.D.
Provider Business Mailing Address
First Line : PO BOX 355
Second Line :
City : GALES FERRY
State : CT
Zip : 06335-0355
Country : US
Telephone Number : 860-464-7253
Fax Number : 860-464-7404
Provider Business Practice Location Address
First Line : 1527 ROUTE 12
Second Line : SUITE 1
City : GALES FERRY
State : CT
Zip : 06335-1800
Country : US
Telephone Number : 860-464-7253
Fax Number : 860-464-7404
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/14/2006
Last Update Date : 11/30/2012

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