Provider Demographics
NPI:1821674714
Name:PERREAULT, JACLYN (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:
Last Name:PERREAULT
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1085 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5719
Mailing Address - Country:US
Mailing Address - Phone:401-415-4200
Mailing Address - Fax:401-415-4348
Practice Address - Street 1:1085 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5719
Practice Address - Country:US
Practice Address - Phone:401-415-4200
Practice Address - Fax:401-415-4348
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD19843207RH0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine