Provider Demographics
NPI:1508857970
Name:PARRIS, JEANETTE S (MD)
Entity Type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:S
Last Name:PARRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10 NEW DRIFTWAY
Mailing Address - Street 2:STE 201
Mailing Address - City:SCITUATE
Mailing Address - State:MA
Mailing Address - Zip Code:02066-4530
Mailing Address - Country:US
Mailing Address - Phone:781-545-9225
Mailing Address - Fax:781-545-8560
Practice Address - Street 1:10 NEW DRIFTWAY
Practice Address - Street 2:STE 201
Practice Address - City:SCITUATE
Practice Address - State:MA
Practice Address - Zip Code:02066-4530
Practice Address - Country:US
Practice Address - Phone:781-545-9225
Practice Address - Fax:781-545-8560
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA78950208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
400022OtherTUFTS USFHP
MA3198812Medicaid
MA201006OtherHPHC
355282OtherCIGNA
MAPAJ16387OtherBCBS
756268OtherTUFTS
MA201006OtherHPHC
MAPAJ16387OtherBCBS