Provider Demographics
NPI:1447341961
Name:PETERS-GEE, JILL M (MD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:PETERS-GEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 FARMINGTON AVENUE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032
Mailing Address - Country:US
Mailing Address - Phone:860-678-7300
Mailing Address - Fax:860-677-2693
Practice Address - Street 1:499 FARMINGTON AVENUE
Practice Address - Street 2:SUITE 220
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032
Practice Address - Country:US
Practice Address - Phone:860-678-7300
Practice Address - Fax:860-677-2693
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031805208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001318056Medicaid
160001597Medicare ID - Type Unspecified
CT001318056Medicaid