Provider Demographics
NPI:1164494456
Name:AHEARN, JENNIFER (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:AHEARN
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 1:1030 PRESIDENT AVE
Mailing Address - Street 2:SOUTHCOAST PHYSICIAN SERVICES INC
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-3703
Mailing Address - Country:US
Mailing Address - Phone:508-679-7398
Mailing Address - Fax:
Practice Address - Street 1:1030 PRESIDENT AVE
Practice Address - Street 2:SOUTHCOAST PHYSICIAN SERVICES INC
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-3703
Practice Address - Country:US
Practice Address - Phone:508-679-7398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA58761207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3136027Medicaid
MAJ13237Medicare ID - Type Unspecified
MA3136027Medicaid