Provider Demographics
NPI:1558343954
Name:GERMAIN, JACQUELINE J (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:J
Last Name:GERMAIN
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 1:122 ROSEMARY RD
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-7027
Mailing Address - Country:US
Mailing Address - Phone:781-326-4159
Mailing Address - Fax:617-234-7981
Practice Address - Street 1:YOUVILLE HOSPITAL
Practice Address - Street 2:1575 CAMBRIDGE STREET
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4398
Practice Address - Country:US
Practice Address - Phone:617-876-4344
Practice Address - Fax:617-234-7981
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA43448208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6187978Medicaid
J04042Medicare ID - Type Unspecified
MA6187978Medicaid