Provider Demographics
NPI:1164576658
Name:JEANTY, GEORGETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGETTE
Middle Name:
Last Name:JEANTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:GEORGETTE
Other - Middle Name:
Other - Last Name:JEANTY LINDOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1525 BLUE HILL AVE
Mailing Address - Street 2:POBOX 260368
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126-1702
Mailing Address - Country:US
Mailing Address - Phone:617-298-0156
Mailing Address - Fax:617-296-2979
Practice Address - Street 1:1525 BLUE HILL AVE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-1702
Practice Address - Country:US
Practice Address - Phone:617-298-0156
Practice Address - Fax:617-296-2979
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA44266207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0001717OtherNEIGHBORHOOD HLTH CARE
MACA0538OtherRAILROAD MEDICARE
MA44266OtherTUFTS ASSOCIATED HEALTH
MA84288OtherUSH AETNA
MA66984UHOtherHARVARD PILGRIM
MA2085259Medicaid
MAC15090OtherBCBS
MA44266OtherTUFTS ASSOCIATED HEALTH
MA66984UHOtherHARVARD PILGRIM