Provider Demographics
NPI:1326038456
Name:ROBERTS, JESSE DAVID JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:DAVID
Last Name:ROBERTS
Suffix:JR
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:55 FRUIT STREET FND 442
Practice Address - Street 2:MASSACHUSETTS GENERAL HOSPITAL NEW BORN SERVICE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-726-9040
Practice Address - Fax:617-726-9346
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA73198207L00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA073198OtherTUFTS HEALTH PLAN
MA3074196Medicaid
MAJ10293OtherBCBS MA
MA3074196Medicaid
MAJ10293Medicare ID - Type Unspecified