Provider Demographics
NPI:1164556130
Name:BLAND, JESSICA K (MD MSPT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:K
Last Name:BLAND
Suffix:
Gender:F
Credentials:MD MSPT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:K
Other - Last Name:BLAND STEMMONS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD MSPT
Mailing Address - Street 1:690 CANTON ST
Mailing Address - Street 2:SUITE 325
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-2321
Mailing Address - Country:US
Mailing Address - Phone:781-407-7713
Mailing Address - Fax:
Practice Address - Street 1:759 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01199-1001
Practice Address - Country:US
Practice Address - Phone:413-796-7494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0600003406390200000X
MA243108207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program