Provider Demographics
NPI:1598701179
Name:PATERSON, JENNIFER (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PATERSON
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 1:195 WORCESTER ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-5568
Mailing Address - Country:US
Mailing Address - Phone:617-219-1510
Mailing Address - Fax:617-219-1512
Practice Address - Street 1:195 WORCESTER ST
Practice Address - Street 2:SUITE 102
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-5568
Practice Address - Country:US
Practice Address - Phone:617-219-1510
Practice Address - Fax:617-219-1512
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA156172207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3177327Medicaid
MA3177327Medicaid
MAG70733Medicare UPIN