Provider Demographics
NPI:1154483931
Name:JAWORSKI, MAVIS WEBSTER (MD)
Entity Type:Individual
Prefix:DR
First Name:MAVIS
Middle Name:WEBSTER
Last Name:JAWORSKI
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:PO BOX 511
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-0411
Mailing Address - Country:US
Mailing Address - Phone:978-225-0022
Mailing Address - Fax:
Practice Address - Street 1:25 HALE ST
Practice Address - Street 2:FLOOR 1
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-5268
Practice Address - Country:US
Practice Address - Phone:978-921-5885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151523207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA22245Medicare ID - Type Unspecified
MAG43620Medicare UPIN