Provider Demographics
NPI:1639131352
Name:TRISTER, JON (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:
Last Name:TRISTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WINTHROP ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-4435
Mailing Address - Country:US
Mailing Address - Phone:508-754-9950
Mailing Address - Fax:508-754-2592
Practice Address - Street 1:10 WINTHROP ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-4435
Practice Address - Country:US
Practice Address - Phone:508-754-9950
Practice Address - Fax:508-754-2592
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA80587207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA784631OtherEMPIRE B/C NY
MA080587OtherTUFTS
MA431050OtherCMHC
MA735473 101683OtherAETNA
MA985162OtherNETWORK
MA0400053OtherUNITED HEALTH CARE
MA431050PROtherHEALTHSOURCE
MA0735473 CAP # 44559OtherUS HEALTH CARE
MA3144941Medicaid
MAJ16290OtherBLUE CROSS BLUE SHIELD
MA29736OtherFALLON
MA66212OtherHARVARD PILGRIM
MA0400664OtherEVER CARE
MA1928586OtherCIGNA
MA1928586OtherCIGNA
MAA20570Medicare ID - Type Unspecified
MA784631OtherEMPIRE B/C NY