Provider Demographics
NPI:1932368909
Name:JOE, JENNIFER MARIE (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:JOE
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 1:28 STATE ST
Mailing Address - Street 2:SUITE 2850
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-1775
Mailing Address - Country:US
Mailing Address - Phone:617-903-5000
Mailing Address - Fax:617-903-5009
Practice Address - Street 1:28 STATE ST
Practice Address - Street 2:SUITE 2850
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-1775
Practice Address - Country:US
Practice Address - Phone:617-903-5000
Practice Address - Fax:617-903-5009
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA246620207R00000X
VA0101244616207R00000X
DCMD037695207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine