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NPI Code Detail

MEDICARE: MARIANNE JACKSON DO

MEDICARE: MARIANNE JACKSON DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology Physician6864NH

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1POOO91565OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
30100920Y0NH02OTHERNHANTHEM BC/BS
46236954OTHERNHCIGNA HEALTHCARE
55830418OTHERAETNA GROUP

General Provider Information

NPI Number : 1184626012
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIANNE JACKSON DO
Provider Business Mailing Address
First Line : 133 PLEASANT ST
Second Line :
City : BERLIN
State : NH
Zip : 03570-2006
Country : US
Telephone Number : 603-752-2040
Fax Number : 603-752-7797
Provider Business Practice Location Address
First Line : 133 PLEASANT ST
Second Line :
City : BERLIN
State : NH
Zip : 03570-2006
Country : US
Telephone Number : 603-752-2040
Fax Number : 603-752-7797
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2005
Last Update Date : 03/07/2023

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Directions to “ MARIANNE JACKSON DO” Practice Location

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