Provider Demographics
NPI:1215909072
Name:PUCHALSKI, JONATHAN THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:THOMAS
Last Name:PUCHALSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:350 GOOSE LN STE 203B
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2492
Mailing Address - Country:US
Mailing Address - Phone:203-738-7700
Mailing Address - Fax:203-689-6500
Practice Address - Street 1:350 GOOSE LN STE 203B
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2492
Practice Address - Country:US
Practice Address - Phone:203-738-7700
Practice Address - Fax:203-689-6500
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT047218207RC0200X, 207RP1001X
OH35077075207RP1001X
PAMD432420207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2360761Medicaid
7306791Medicare ID - Type Unspecified
H73792Medicare UPIN