Provider Demographics
NPI:1205832821
Name:FEHSER, JENNIFER K (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:FEHSER
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 9120
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02027-9120
Mailing Address - Country:US
Mailing Address - Phone:780-329-1400
Mailing Address - Fax:781-278-5667
Practice Address - Street 1:1 LYONS ST
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-5599
Practice Address - Country:US
Practice Address - Phone:781-329-1400
Practice Address - Fax:781-278-5667
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219963208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
0033559OtherNEIGHBORHOOD HEALTH
3812682OtherCIGNA
469664OtherTUFTS COMMONWEALTH
AA15713OtherFIRST SENIORITY
70083OtherCHILDREN'S MEDICAL SECURI
469664OtherTUFTS BENEFITS
469664OtherTUFTS TOTAL HEALTH PLAN
AA15713OtherHARVARD PILGRIM PPO
469664OtherTUFTS
2081270OtherMASS. HEALTH
MA3812682OtherHEALTHSOURCE
J27831OtherHMO BLUE/BLUE COICE
AA15713OtherHARVARD/PILGRIM
J27831OtherBS-BLUE CARE ELECT
AA15713OtherHARVARD PILGRIM POS
J27831OtherBLUE SHEILD
469664OtherTUFTS TOTAL HEALTH PLAN
AA15713OtherHARVARD/PILGRIM