MEDICARE: DR. JENNIFER BUCHANAN DPM

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
1	213E00000X	Podiatrist	2417	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	S400166574	OTHER	MA	PTAN

General Provider Information

NPI Number	:	1114214616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER BUCHANAN DPM

Provider Business Mailing Address
First Line	:	CAMBRIDGE HOSPITAL
Second Line	:	1493 CAMBRIDGE STREET
City	:	CAMBRIDGE
State	:	MA
Zip	:	02139-2137
Country	:	US
Telephone Number	:	617-665-2555
Fax Number	:	617-665-3598

Provider Business Practice Location Address
First Line	:	CAMBRIDGE HOSPITAL
Second Line	:	1493 CAMBRIDGE STREET
City	:	CAMBRIDGE
State	:	MA
Zip	:	02139-2137
Country	:	US
Telephone Number	:	617-665-2555
Fax Number	:	617-665-3598

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2011
Last Update Date	:	05/24/2019

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