Provider Demographics
NPI:1033309588
Name:MACRIE, JESSICA WEBSTER (DO)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:WEBSTER
Last Name:MACRIE
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:1290 SILAS DEANE HWY FL 1
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4337
Mailing Address - Country:US
Mailing Address - Phone:860-972-6970
Mailing Address - Fax:860-972-7040
Practice Address - Street 1:73 WATERBURY ROAD
Practice Address - Street 2:
Practice Address - City:SUITE 1
Practice Address - State:CT
Practice Address - Zip Code:06109-4337
Practice Address - Country:US
Practice Address - Phone:203-527-9444
Practice Address - Fax:203-527-9332
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2020-09-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC134164207Q00000X
CT64340207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT64340OtherCT LIC
NC2075358Medicare PIN