Provider Demographics
NPI:1043356876
Name:KREMER, JO R (MD)
Entity type:Individual
Prefix:
First Name:JO
Middle Name:R
Last Name:KREMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JO
Other - Middle Name:KREMER
Other - Last Name:SAROWITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:34 PARK ST
Mailing Address - Street 2:CONNECTICUT MENTAL HEALTH CENTER OFFICE OF CARE MANAGEM
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519
Mailing Address - Country:US
Mailing Address - Phone:203-974-7417
Mailing Address - Fax:203-974-7413
Practice Address - Street 1:34 PARK ST
Practice Address - Street 2:CONNECTICUT MENTAL HEALTH CENTER
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519
Practice Address - Country:US
Practice Address - Phone:203-974-7417
Practice Address - Fax:203-974-7413
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT0249012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004235918Medicaid
B83472Medicare UPIN
CT260004171Medicare ID - Type UnspecifiedFIRST COAST