Provider Demographics
NPI:1629058979
Name:RISTAINO, JEFFREY R (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:R
Last Name:RISTAINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 BAKER AVE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2129
Mailing Address - Country:US
Mailing Address - Phone:978-287-9400
Mailing Address - Fax:978-287-9408
Practice Address - Street 1:330 BAKER AVE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2129
Practice Address - Country:US
Practice Address - Phone:978-287-9400
Practice Address - Fax:978-287-9408
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA156722208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3182681Medicaid
MA1202088OtherUNITED HEALTHCARE
MA156722OtherTUFTS
MA201805OtherHARVARD PILGRIM
MAJ19117OtherBLUE CROSS
MAB10329302OtherCIGNA
MA0016165OtherNEIGHBORHOOD HEALTH
MA5189645OtherAETNA
MA156722OtherTUFTS
MAJ19117OtherBLUE CROSS