Provider Demographics
NPI:1740211200
Name:CLIFFORD, JEANNE STEINBERG (MD)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:STEINBERG
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:WYN
Other - Last Name:STEINBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:101 MAIN ST.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4540
Mailing Address - Country:US
Mailing Address - Phone:781-396-1288
Mailing Address - Fax:781-391-1989
Practice Address - Street 1:101 MAIN ST.
Practice Address - Street 2:SUITE 201
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-4540
Practice Address - Country:US
Practice Address - Phone:781-396-1288
Practice Address - Fax:781-391-1989
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA70413208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3052435Medicaid
E19406Medicare UPIN
MA3052435Medicaid