Provider Demographics
NPI:1255543013
Name:GOMES, JENNIFER (RT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GOMES
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 NORFOLK AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02375-1157
Mailing Address - Country:US
Mailing Address - Phone:508-238-0060
Mailing Address - Fax:508-238-0786
Practice Address - Street 1:5 NORFOLK AVE
Practice Address - Street 2:
Practice Address - City:SOUTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02375-1157
Practice Address - Country:US
Practice Address - Phone:508-238-0060
Practice Address - Fax:508-238-0786
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist