Provider Demographics
NPI:1700868932
Name:LABONTE, JENNIFER W (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:W
Last Name:LABONTE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:45 STERLING ST STE 22
Mailing Address - Street 2:
Mailing Address - City:WEST BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01583-1201
Mailing Address - Country:US
Mailing Address - Phone:774-772-5161
Mailing Address - Fax:774-893-8608
Practice Address - Street 1:45 STERLING ST STE 22
Practice Address - Street 2:
Practice Address - City:WEST BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01583-1201
Practice Address - Country:US
Practice Address - Phone:774-772-5161
Practice Address - Fax:774-893-8608
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2022-02-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA204383207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0103748Medicaid
MALA A31304Medicare ID - Type Unspecified
MA0103748Medicaid