Individual
JEANETTE M TETRAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1 LONG WHARF DR, NEW HAVEN, CT 06511-5991
(203) 781-4600
(203) 781-4624
Mailing address
1 LONG WHARF DR, NEW HAVEN, CT 06511-5991
(203) 781-4600
(203) 781-4624
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
042313
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001423136
—
CT
05
—
004041000
—
CT
05
—
004082260
—
CT
05
—
004082286
—
CT
05
—
004217099
—
CT
05
—
008001325
—
CT
05
—
008022622
—
CT
05
—
008022626
—
CT
05
—
008023170
—
CT
05
—
008024427
—
CT
05
—
008039745
—
CT
05
—
008042339
—
CT
05
—
500000315
—
CT
01
—
C01033
MEDICARE PTAN
CT
01
—
D400081097
MEDICARE GROUP MEMBER PIN/PTAN
CT
Enumeration date
07/12/2006
Last updated
01/24/2022
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