Provider Demographics
NPI:1558345561
Name:KASPER, JILL E (MD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:E
Last Name:KASPER
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 1:300 BROADWAY
Mailing Address - Street 2:SOMERVILLE PEDIATRICS
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-2935
Mailing Address - Country:US
Mailing Address - Phone:617-284-7000
Mailing Address - Fax:
Practice Address - Street 1:300 BROADWAY
Practice Address - Street 2:SOMERVILLE PEDIATRICS
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145
Practice Address - Country:US
Practice Address - Phone:617-284-7000
Practice Address - Fax:617-284-7080
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220624208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA37168Medicare PIN