Provider Demographics
NPI:1235120601
Name:JOLLES, JON R (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:R
Last Name:JOLLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:51 MILL ST
Mailing Address - Street 2:BUILDING E - 17
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-1641
Mailing Address - Country:US
Mailing Address - Phone:781-826-2131
Mailing Address - Fax:781-826-4513
Practice Address - Street 1:51 MILL ST
Practice Address - Street 2:BUILDING E - 17
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-1641
Practice Address - Country:US
Practice Address - Phone:781-826-2131
Practice Address - Fax:781-826-4513
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA45558208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJOJ08024OtherBCBS
MA0194069Medicaid
MA20603OtherHPHC
3552812OtherCIGNA
721287OtherTUFTS
1200529OtherUNITED
MAJOJ08024OtherBCBS
721287OtherTUFTS