Healthcare Provider Details

I. General information

NPI: 1992480909
Provider Name (Legal Business Name): MADISON RILEY JEBB PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADISON PIRRONE PA-C

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 WORCESTER RD
BARRE MA
01005-9099
US

IV. Provider business mailing address

PO BOX 415348
BOSTON MA
02241-5348
US

V. Phone/Fax

Practice location:
  • Phone: 978-355-6321
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9529
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: