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1922024033 NPI number — PETER J JENKIN MD

NPI Number: 1922024033
Health Care Provider/Practitioner: PETER J JENKIN MD

Information about “1922024033” NPI (PETER J JENKIN MD) exists in 1922024033 in HTML format HTML  |  1922024033 in plain Text format TXT  |  1922024033 in PDF (Portable Document Format) PDF  |  1922024033 in an XML format XML  formats.

NPI Number : 1922024033 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1922024033",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JENKIN",
    "FirstName": "PETER",
    "MiddleName": "J",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "526 MAIN ST STE 302",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ACTON",
    "MailingAddressStateName": "MA",
    "MailingAddressPostalCode": "01720-3301",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "789-371-7010",
    "MailingAddressFaxNumber": "978-371-0522",
    "FirstLinePracticeLocationAddress": "87 MCGREGOR ST STE 2100",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MANCHESTER",
    "PracticeLocationAddressStateName": "NH",
    "PracticeLocationAddressPostalCode": "03102-3767",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "603-626-7546",
    "PracticeLocationAddressFaxNumber": "603-626-7548",
    "EnumerationDate": "07/14/2006",
    "LastUpdateDate": "09/17/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207N00000X",
          "TaxonomyName": "Dermatology Physician",
          "LicenseNumber": "MD00037526",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207N00000X",
          "TaxonomyName": "Dermatology Physician",
          "LicenseNumber": "25285",
          "LicenseNumberStateCode": "NH",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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