Provider Demographics
NPI:1265721336
Name:HOOTNICK, JESSICA LAUREN (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LAUREN
Last Name:HOOTNICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3 MEETING HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-2738
Mailing Address - Country:US
Mailing Address - Phone:978-256-5557
Mailing Address - Fax:978-256-1835
Practice Address - Street 1:3 MEETING HOUSE RD
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-2738
Practice Address - Country:US
Practice Address - Phone:978-256-5557
Practice Address - Fax:978-256-1835
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2017-03-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA266864207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology