JEAN M HENNEBERY (Credential# 1241095) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is October 1, 2019. The license expiration date date is September 30, 2020. The license status is ACTIVE.
JEAN M HENNEBERY is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.053620. The credential type is physician/surgeon. The effective date is October 1, 2019. The expiration date is September 30, 2020. The business address is 759 Chestnut St, Springfield, MA 01199-1001. The current status is active.
| Licensee Name | JEAN M HENNEBERY |
| Credential ID | 1241095 |
| Credential Number | 1.053620 |
| Credential Type | Physician/Surgeon |
| Business Address |
759 Chestnut St Springfield MA 01199-1001 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2014-10-24 |
| Effective Date | 2019-10-01 |
| Expiration Date | 2020-09-30 |
| Refresh Date | 2019-07-10 |
| Street Address | 759 CHESTNUT ST |
| City | SPRINGFIELD |
| State | MA |
| Zip Code | 01199-1001 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Richard M Engelman | 759 Chestnut St, Springfield, MA 01199 | Physician/surgeon | 2016-11-01 ~ 2017-10-31 |
| Lawrence C Peters | 759 Chestnut St, Springfield, MA 01199 | Physician/surgeon | 2016-08-01 ~ 2017-07-31 |
| James Van Bavel | 759 Chestnut St, Springfield, MA 01107-1619 | Physician/surgeon | 1972-06-22 ~ 1980-07-30 |
| Alok Kumar | 759 Chestnut St, Springfield, MA 01199-1001 | Physician/surgeon | ~ |
| Baystate Health Foundation Inc. | 759 Chestnut St, Springfield, MA 01199-1001 | Public Charity-exempt From Financial Requirements | ~ |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Katya Ford · Ivanov | Baystate Medical Center, Springfield, MA 01199 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Franklin Moore | Departmentt of Pathology, 759 Chestnut St, MA 01199 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Oren W Johnson | 758 Chestnut Street, Springfield, MA 01199 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Kimberly Ann Bucknor | 3400 B Main Street, Springfield, MA 01199 | Controlled Substance Registration for Practitioner | 2020-02-03 ~ 2021-02-28 |
| Kelly A Lynch | Baystate Medical Center, Dept. of Obgyn, Springfield, MA 01199 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Orlando L Torres | 140 High Street, Springfield, MA 01199 | Physician/surgeon | 2005-11-21 ~ 2006-07-31 |
| Christopher N Otis | Baystate Medical Center, Springfield, MA 01199 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Kelly M Tyler | Baystate Medical Center, Springfield, MA 01199 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Neal E Seymour | Baystate Medical Center, Springfield, MA 01199 | Physician/surgeon | 2019-08-01 ~ 2020-07-31 |
| Venkatrao Medarametla | C3350; Hospital Medidine, Springfield, MA 01199-0001 | Physician/surgeon | 2020-09-01 ~ 2021-08-31 |
| Find all Licenses in zip 01199 | |||
| City | SPRINGFIELD |
| Zip Code | 01199 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + SPRINGFIELD |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Jean K Yi | 2 Old Barn Ln, Malvern, PA 19355-3306 | Physician/surgeon | 2016-01-01 ~ 2016-12-31 |
| Prathima Kanumuri | 12 Jean Dr, Towaco, NJ 07082-1216 | Physician/surgeon | 2014-04-01 ~ 2015-03-31 |
| Jean B Case | 54 Tanglewylde Ave, Bronxville, NY 10708 | Physician/surgeon | 2005-03-24 ~ 2006-05-31 |
| Jean P Simon | 36 E 70 Th Street, New York, NY 10021 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Jean R Haymond | 820 Wallberg Ave, Westfield, NJ 07090 | Physician/surgeon | 1995-07-20 ~ 1996-06-30 |
| Jean Rhee | 112 Independence Trl, Totowa, NJ 07512-2808 | Physician/surgeon | 2013-10-28 ~ 2014-01-31 |
| Alan Studner | 303 Jean Pl, Vienna, VA 22180 | Physician/surgeon | 1993-09-23 ~ 1994-11-30 |
| Jean Wong Md | 455 Lewis Ave Ste 210, Meriden, CT 06451-2121 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Smita Bhatt | 5 Jean Pl, Syosset, NY 11791-5914 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Jean M Weigert | 124 Hebron Ave Ste 1b, Glastonbury, CT 06033-2066 | Physician/surgeon | 2020-09-01 ~ 2021-08-31 |
Please comment or provide details below to improve the information on JEAN M HENNEBERY.
| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).