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NPI Code Detail

MEDICARE: DR. LAURA LEA JETT M.D.

MEDICARE: DR. LAURA LEA JETT M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician015052ME
2207Q00000XFamily Medicine Physician257310MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114013794
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LAURA LEA JETT M.D.
Provider Business Mailing Address
First Line : 36 ESSEX RD
Second Line : LAHEY HEALTH PRIMARY CARE, IPSWICH
City : IPSWICH
State : MA
Zip : 01938-2599
Country : US
Telephone Number : 978-356-5522
Fax Number :
Provider Business Practice Location Address
First Line : 36 ESSEX RD
Second Line : LAHEY HEALTH PRIMARY CARE, IPSWICH
City : IPSWICH
State : MA
Zip : 01938-2599
Country : US
Telephone Number : 978-356-5522
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 03/17/2017

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1184725566 — CARL A SODERLAND MD
Practice Location Address:
36 ESSEX ST , LAHEY CLINIC
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1477602209 — DR. EUGENE J. BOSS M.D.
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