Provider Demographics
NPI:1144203993
Name:JARRY, P DAVID (MD,FACP,MBA)
Entity Type:Individual
Prefix:DR
First Name:P DAVID
Middle Name:
Last Name:JARRY
Suffix:
Gender:M
Credentials:MD,FACP,MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 HARVEST CIR
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-1498
Mailing Address - Country:US
Mailing Address - Phone:508-829-9390
Mailing Address - Fax:508-829-4638
Practice Address - Street 1:70 HARVEST CIR
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520-1498
Practice Address - Country:US
Practice Address - Phone:508-829-9390
Practice Address - Fax:508-829-4638
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-25
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA38355207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2073048Medicaid
MAN01651Medicare ID - Type Unspecified
B99301Medicare UPIN