Provider Demographics
NPI:1649373986
Name:BRAIMON, JENNIFER C (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:BRAIMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:ONE ESSEX CENTER DRIVE
Mailing Address - Street 2:LAHEY CLINIC
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2901
Mailing Address - Country:US
Mailing Address - Phone:978-538-4674
Mailing Address - Fax:978-538-4712
Practice Address - Street 1:ONE ESSEX CENTER DRIVE
Practice Address - Street 2:LAHEY CLINIC
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2901
Practice Address - Country:US
Practice Address - Phone:978-977-6336
Practice Address - Fax:978-538-4712
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2012-09-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA77394207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110059748AMedicaid
F72935Medicare UPIN
MAMX5950Medicare PIN
MA110059748AMedicaid