MEDICARE: DR. MARY CAROL JENNINGS 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
1	207V00000X	Obstetrics & Gynecology Physician	244932	MA

General Provider Information

NPI Number	:	1700106275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY CAROL JENNINGS M.D.

Provider Business Mailing Address
First Line	:	455 MASSACHUSETTS AVE
Second Line	:	#3
City	:	BOSTON
State	:	MA
Zip	:	02118-1111
Country	:	US
Telephone Number	:	864-992-3391
Fax Number	:

Provider Business Practice Location Address
First Line	:	85 E CONCORD ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02118-2335
Country	:	US
Telephone Number	:	617-414-5166
Fax Number	:

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

Provider Enumeration Date	:	06/08/2010
Last Update Date	:	06/08/2010

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