Provider Demographics
NPI:1114214616
Name:BUCHANAN, JENNIFER (DPM)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CAMBRIDGE HOSPITAL
Mailing Address - Street 2:1493 CAMBRIDGE STREET
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-2137
Mailing Address - Country:US
Mailing Address - Phone:617-665-2555
Mailing Address - Fax:617-665-3598
Practice Address - Street 1:CAMBRIDGE HOSPITAL
Practice Address - Street 2:1493 CAMBRIDGE STREET
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-2137
Practice Address - Country:US
Practice Address - Phone:617-665-2555
Practice Address - Fax:617-665-3598
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2417213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS400166574OtherPTAN
MA204328799OtherGROUP TAX ID#