Provider Demographics
NPI:1649239757
Name:ETEN, JOHN L (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:ETEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:204 MAIN ST
Mailing Address - Street 2:ORLEANS MEDICAL CENTER, P.C.
Mailing Address - City:ORLEANS
Mailing Address - State:MA
Mailing Address - Zip Code:02653-3428
Mailing Address - Country:US
Mailing Address - Phone:508-255-8825
Mailing Address - Fax:
Practice Address - Street 1:204 MAIN ST
Practice Address - Street 2:ORLEANS MEDICAL CENTER, P.C.
Practice Address - City:ORLEANS
Practice Address - State:MA
Practice Address - Zip Code:02653-3428
Practice Address - Country:US
Practice Address - Phone:508-255-8825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA51173207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
01-00821OtherUNITED HEALTHCARE
MA6185932Medicaid
723878OtherTUFTS HEALTHCARE
B10436901OtherCIGNA HEALTHCARE
000000031977OtherBOSTON MEDICAL HEALTHNET
MA28599OtherCHILDREN'S MEDICAL SECURI
7725OtherHARVARDPILGRIM HEALTHCARE
080130572OtherRAIL ROAD MEDICARE
MAJ03410OtherBLUE CROSS BLUE SHIELD
000000031977OtherBOSTON MEDICAL HEALTHNET
723878OtherTUFTS HEALTHCARE