Individual
JENNIFER TORP HAILE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
76 NEW BRITAIN AVE, HARTFORD, CT 06106-3305
(860) 545-9300
(860) 837-6801
Mailing address
169 FARMDALE ROAD, WATERTOWN, CT 06795-2632
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
050760
CT
208000000X
Pediatrics Physician
MD.203198
LA
390200000X
Student in an Organized Health Care Education/Training Program
PGY.1.TUL-PEDS
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01578320
—
MS
05
—
1003051
—
LA
05
—
1700060787
—
CT
Enumeration date
12/26/2007
Last updated
09/13/2022
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