Provider Demographics
NPI:1235186602
Name:JIMENEZ, AGNES A (MD)
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:A
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:100 CUMMINGS CTR
Mailing Address - Street 2:SUITE 126Q
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6115
Mailing Address - Country:US
Mailing Address - Phone:978-524-8181
Mailing Address - Fax:978-524-9868
Practice Address - Street 1:100 CUMMINGS CTR
Practice Address - Street 2:SUITE 126Q
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6115
Practice Address - Country:US
Practice Address - Phone:978-524-8181
Practice Address - Fax:978-524-9868
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2016-01-07
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Provider Licenses
StateLicense IDTaxonomies
MA226287207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110041759AMedicaid
MA110041759AMedicaid