Healthcare Provider Details

I. General information

NPI: 1316384431
Provider Name (Legal Business Name): JACQUELYN CHAMBERS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2013
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2621
US

IV. Provider business mailing address

74 LOOMIS ST
BEDFORD MA
01730-2248
US

V. Phone/Fax

Practice location:
  • Phone: 781-674-2900
  • Fax: 781-275-0688
Mailing address:
  • Phone: 781-274-2900
  • Fax: 781-275-0688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number266003
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: