Provider Demographics
NPI:1851482418
Name:SPENCER, JACQUELINE KAREN (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:KAREN
Last Name:SPENCER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 LANCASTER ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-2839
Mailing Address - Country:US
Mailing Address - Phone:914-522-5666
Mailing Address - Fax:
Practice Address - Street 1:30 LANCASTER ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-2839
Practice Address - Country:US
Practice Address - Phone:914-522-5666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78385207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA02149008Medicaid
MA02149008Medicaid
MA835701Medicare PIN