Healthcare Provider Details

I. General information

NPI: 1851686034
Provider Name (Legal Business Name): JENNIFER SERVIDAD MEAD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 06/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST HEMATOLOGY CENTER, YAWKEY SUITE 7B
BOSTON MA
02114-2621
US

IV. Provider business mailing address

55 FRUIT STREET YAWKEY SUITE 7B MASS GENERAL HOSPITAL CANCER CENTER HEMATOLOGY CENTER
BOSTON MA
02114
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-4000
  • Fax:
Mailing address:
  • Phone: 617-724-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA4109
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: