Provider Demographics
NPI:1427044528
Name:SOUTHER, JENNIFER (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:SOUTHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MARTIN STREET
Mailing Address - Street 2:UNIT #30A
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-5321
Mailing Address - Country:US
Mailing Address - Phone:401-334-4500
Mailing Address - Fax:401-312-0096
Practice Address - Street 1:30 MARTIN STREET
Practice Address - Street 2:UNIT #30A
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-5321
Practice Address - Country:US
Practice Address - Phone:401-334-4500
Practice Address - Fax:401-312-0096
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10848207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI01-02493OtherUNITED HEALTH CARE
RIP12001018OtherMULTIPLAN
RI409677OtherBLUE CHIP
RI320874OtherBLUE CROSS/BLUE SHIELD
RIRI2966OtherACHS NON-PAR
RIAA242OtherHARVARD HEALTH PLAN
RI7133474OtherAETNA
RI7468665OtherCIGNA
RI7133474OtherAETNA