Provider Demographics
NPI:1033476627
Name:ABESKHERON, JOLLY (MD)
Entity Type:Individual
Prefix:
First Name:JOLLY
Middle Name:
Last Name:ABESKHERON
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 1:1 PEARL ST
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2864
Mailing Address - Country:US
Mailing Address - Phone:508-897-6060
Mailing Address - Fax:508-897-6063
Practice Address - Street 1:1 PEARL ST
Practice Address - Street 2:SUITE 1000
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2864
Practice Address - Country:US
Practice Address - Phone:508-897-6060
Practice Address - Fax:508-897-6063
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA265584207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine