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General NPI Number Information
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NPI Number | 1134357304
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Entity Type | Individual
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Provider Name | JESSICA EARLY MD
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Gender | Female
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Dates
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Enumeration Date | 06/26/2009
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Last Update Date | 08/02/2013
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Provider Practice Location Address
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Address Line | 195 CANAL ST
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City | MALDEN
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State | MA
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Zip | 02148-6701
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Country | US
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Telephone | 617-338-0500
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Fax | 617-338-0000
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Provider Business Mailing Address
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Address Line | 195 CANAL ST
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City | MALDEN
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State | MA
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Zip | 02148-6701
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Country | US
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Telephone | 617-338-0500
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Fax | 617-338-0000
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | LP01654
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 253516
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License Number State | MA
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