Provider Demographics
NPI:1295707016
Name:AMATO, JACQUELINE M (MD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:M
Last Name:AMATO
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 1:841 ALDERCREEK DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8900
Mailing Address - Country:US
Mailing Address - Phone:541-858-7188
Mailing Address - Fax:541-858-7186
Practice Address - Street 1:841 ALDERCREEK DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8900
Practice Address - Country:US
Practice Address - Phone:541-858-7188
Practice Address - Fax:541-858-7186
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD228162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR108891Medicare PIN
ORRR PTAN 260046512Medicare PIN