Provider Demographics
NPI:1215911789
Name:EVERETT, JAMES R (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:EVERETT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10 WILLARD ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-1281
Mailing Address - Country:US
Mailing Address - Phone:617-479-1452
Mailing Address - Fax:617-479-3500
Practice Address - Street 1:51 PERFORMANCE DR
Practice Address - Street 2:SUITE 110
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-3141
Practice Address - Country:US
Practice Address - Phone:781-337-9091
Practice Address - Fax:781-331-6355
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2014-01-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA33778207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0084904OtherAETNA US HEALTH
MA2047039Medicaid
MA706885OtherTUFTS HEALTH CARE
MAB20150301OtherCIGNA
MA14010OtherHARVARD PILGRIM
MAJ23017OtherBLUE CROSS BLUE SHIELD
MAJ23017OtherBLUE CROSS BLUE SHIELD
MA14010OtherHARVARD PILGRIM