MEDICARE: DR. JACQUELINE OLDS MD

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
1	2084P0800X	Psychiatry Physician	70658	MA

General Provider Information

NPI Number	:	1336139054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACQUELINE OLDS MD

Provider Business Mailing Address
First Line	:	PO BOX 9142
Second Line	:	MASS GENERAL PHYSICIAN ORGANIZATION
City	:	CHARLESTOWN
State	:	MA
Zip	:	02129-9142
Country	:	US
Telephone Number	:	617-724-0287
Fax Number	:	617-726-2894

Provider Business Practice Location Address
First Line	:	30 HILLSIDE AVENUE
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02140
Country	:	US
Telephone Number	:	617-547-5920
Fax Number	:	617-547-7719

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	07/08/2007

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