Individual
JEFFREY GLEN KEGEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5 FOUNDERS ST, WILLIMANTIC, CT 06226
(860) 456-2898
Mailing address
PO BOX 8500-6335, PHILADELPHIA, PA 19178-6335
(215) 831-2355
(215) 831-2017
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
35405
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0014547140005
—
PA
01
—
30062352
KEYSTONE MERCY
PA
01
—
3513564000
KEYSTONE IBC
PA
01
—
41478MD045251E
HEALTH PARTNERS
PA
01
—
5989452
AETNA PPO
PA
01
—
6887720
AETNA HMO
PA
01
—
698880
HIGHMARK BLUE SHIELD
PA
Enumeration date
06/10/2006
Last updated
08/02/2018
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