Provider Demographics
NPI:1659461598
Name:FAY, JANE H (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:H
Last Name:FAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:40 CATERINA HTS
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-4770
Mailing Address - Country:US
Mailing Address - Phone:978-287-3700
Mailing Address - Fax:978-287-3729
Practice Address - Street 1:133 OLD ROAD TO NINE ACRE CORNER
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-4159
Practice Address - Country:US
Practice Address - Phone:978-287-3700
Practice Address - Fax:978-287-3729
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA588952085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3055779Medicaid
MAJ08956Medicare ID - Type UnspecifiedMEDICARE
MA3055779Medicaid