MEDICARE: DR. JEFFREY L ST JOHN M.D.

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	207RG0100X	Gastroenterology Physician	231178	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000043487	OTHER	MA	BMC HEALTHNET
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	J41872	OTHER	MA	BCBSMA
5	AA96200	OTHER	MA	HARVARD PILGRIM HEALTH PLAN
6	1750383170	OTHER	MA	TUFTS HEALTH PLAN
7	7903586	OTHER		AETNA
8	3002785	OTHER	MA	MVP
9	41385	OTHER	MA	HEALTH NEW ENGLAND

General Provider Information

NPI Number	:	1750383170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY L ST JOHN M.D.

Provider Business Mailing Address
First Line	:	777 NORTH ST STE 203
Second Line	:	P.O. BOX 1264
City	:	PITTSFIELD
State	:	MA
Zip	:	01201-4123
Country	:	US
Telephone Number	:	413-499-8590
Fax Number	:	413-499-6410

Provider Business Practice Location Address
First Line	:	777 NORTH ST
Second Line	:	SUITE 203
City	:	PITTSFIELD
State	:	MA
Zip	:	01201-4147
Country	:	US
Telephone Number	:	413-499-8590
Fax Number	:	413-499-6410

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	01/18/2024

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