Healthcare Provider Details

I. General information

NPI: 1992743280
Provider Name (Legal Business Name): JENIFER L JAEGER MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 05/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 MASSAPOAG AVE
SHARON MA
02067-2749
US

IV. Provider business mailing address

720 HARRISON AVE # DOB503
BOSTON MA
02118-2371
US

V. Phone/Fax

Practice location:
  • Phone: 617-877-3510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number10954
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number150523
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: