Individual
JEAN L BOLOGNIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
15 YORK ST, NEW HAVEN, CT 06510-3221
(203) 785-4632
(203) 785-3315
Mailing address
PO BOX 9805, 300 GEORGE ST, 6TH FLOOR, NEW HAVEN, CT 06536-0805
(203) 785-7998
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
025790
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001257906
—
CT
Enumeration date
11/03/2005
Last updated
05/22/2008
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