Provider Demographics
NPI:1245216175
Name:DICKERMAN, JANE (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:DICKERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:91 CENTRAL ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3551
Mailing Address - Country:US
Mailing Address - Phone:781-501-5650
Mailing Address - Fax:781-501-5659
Practice Address - Street 1:91 CENTRAL ST
Practice Address - Street 2:SUITE B
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3551
Practice Address - Country:US
Practice Address - Phone:781-501-5650
Practice Address - Fax:781-501-5659
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2012-07-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA58656207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3028143Medicaid
MA7017OtherAETNA/USHC
MA0003391OtherNEIGHBORHOOD HEALTH PLAN
MA180011813OtherRAILROAD MEDICARE
MA08-00023OtherEVERCARE
MA08-02010OtherUNITED HEALTH CARE
MA15185OtherHARVARD PILGRIM HEALTH CA
MA4864216-002OtherCIGNA PAL
MA3028143Medicaid
MA15185OtherHARVARD PILGRIM HEALTH CA