Provider Demographics
NPI:1649298399
Name:JAY, PATRICIA S (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:S
Last Name:JAY
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 1:170 WORCESTER ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-5506
Mailing Address - Country:US
Mailing Address - Phone:781-431-1333
Mailing Address - Fax:781-431-1933
Practice Address - Street 1:910 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-6022
Practice Address - Country:US
Practice Address - Phone:781-431-1333
Practice Address - Fax:781-431-1933
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA51348207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6195199Medicaid
MAA57934Medicare UPIN
MAJ04634Medicare ID - Type Unspecified