MEDICARE: DR. JON R JOLLES 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
1	208000000X	Pediatrics Physician	45558	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	721287	OTHER		TUFTS
2	JOJ08024	OTHER	MA	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	3552812	OTHER		CIGNA
5	1200529	OTHER		UNITED
6	20603	OTHER	MA	HPHC

General Provider Information

NPI Number	:	1235120601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JON R JOLLES MD

Provider Business Mailing Address
First Line	:	PO BOX 68
Second Line	:
City	:	S WEYMOUTH
State	:	MA
Zip	:	02190-0001
Country	:	US
Telephone Number	:	781-803-2786
Fax Number	:	781-812-1631

Provider Business Practice Location Address
First Line	:	51 MILL ST
Second Line	:	BUILDING E - 17
City	:	HANOVER
State	:	MA
Zip	:	02339-1641
Country	:	US
Telephone Number	:	781-826-2131
Fax Number	:	781-826-4513

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

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	10/03/2024

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