Provider Demographics
NPI:1427027275
Name:SABIR, JENNIFER FOSSAN (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:FOSSAN
Last Name:SABIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNNE
Other - Last Name:FOSSAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:110 W SQUANTUM ST
Mailing Address - Street 2:MANET COMMUNITY HEALTH CENTER
Mailing Address - City:NO QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-2122
Mailing Address - Country:US
Mailing Address - Phone:617-376-3000
Mailing Address - Fax:617-774-1906
Practice Address - Street 1:180 GEORGE WASHINGTON BLVD
Practice Address - Street 2:MANET COMMUNITY HEALTH CENTER INC
Practice Address - City:HULL
Practice Address - State:MA
Practice Address - Zip Code:02045-3069
Practice Address - Country:US
Practice Address - Phone:617-376-3000
Practice Address - Fax:617-774-1906
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226419207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H60433Medicare UPIN
A39546Medicare ID - Type Unspecified