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NPI Code Detail

MEDICARE: DR. REBECCA JACKSON MD

MEDICARE: DR. REBECCA JACKSON MD
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 Physician208092MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2J23829OTHERMABLUE CROSS BLUE SHIELD OF MA
347759OTHERMAHEALTH NEW ENGLAND
4AA159101OTHERMAHARVARD PILGRIM HEALTHCARE
59611148OTHERMAAETNA

General Provider Information

NPI Number : 1114999786
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. REBECCA JACKSON MD
Provider Business Mailing Address
First Line : 119 NEW ATHOL RD STE 200
Second Line :
City : ORANGE
State : MA
Zip : 01364-9603
Country : US
Telephone Number : 978-544-7800
Fax Number : 978-544-0023
Provider Business Practice Location Address
First Line : 119 NEW ATHOL RD STE 200
Second Line :
City : ORANGE
State : MA
Zip : 01364-9603
Country : US
Telephone Number : 978-544-7800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2006
Last Update Date : 07/21/2022

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Directions to “ DR. REBECCA JACKSON MD” Practice Location

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