Provider Demographics
NPI:1801864772
Name:JARDINE, JOHN F (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:JARDINE
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 1:115 CASS AVE
Mailing Address - Street 2:LANDMARK MEDICAL CENTER
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-4705
Mailing Address - Country:US
Mailing Address - Phone:401-767-1510
Mailing Address - Fax:401-767-1557
Practice Address - Street 1:115 CASS AVE
Practice Address - Street 2:LANDMARK MEDICAL CENTER
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-4705
Practice Address - Country:US
Practice Address - Phone:401-767-1510
Practice Address - Fax:401-767-1557
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD12155207P00000X
CT56054207P00000X
MA205253207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ22849Medicaid
MAJ22849Medicaid
H23991Medicare UPIN