Provider Demographics
NPI:1912965369
Name:ENNEGUESS, JEANNE M (DO)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:M
Last Name:ENNEGUESS
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:2 ESSEX CENTER DR
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2926
Mailing Address - Country:US
Mailing Address - Phone:978-532-2800
Mailing Address - Fax:978-977-4491
Practice Address - Street 1:2 ESSEX CENTER DR
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2926
Practice Address - Country:US
Practice Address - Phone:978-532-2800
Practice Address - Fax:978-977-4491
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2021-01-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA154749207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0016135OtherNEIGHBORHOOD HEALTH
MA3214513OtherAETNA
MA1156513-002OtherCIGNA
MAJ18664OtherBLUE CROSS
MA3175855Medicaid
MA775979OtherTUFTS
MA3175855Medicaid
MAJ18664OtherBLUE CROSS