Provider Demographics
NPI:1285692897
Name:ACKMAN, JEANNE BARI (MD)
Entity type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:BARI
Last Name:ACKMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JEANNE
Other - Middle Name:BARI
Other - Last Name:ACKMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:23 NOBSCOT RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493-1146
Mailing Address - Country:US
Mailing Address - Phone:617-724-4254
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:MGH DEPARTMENT OF RADIOLOGY, FOUNDERS HOUSE 2
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-724-4254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1543072085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0028726OtherNEIGHBORHOOD HEALTH PLAN
250726OtherHARVARD PILGRIM HEALTH CA
MA3174212Medicaid
000000027977OtherBMC HEALTHNET
39133OtherFALLON COMMUNITY HEALTH P
774897OtherTUFTS HEALTH PLAN
MAJ18419OtherBLUE SHIELD OF MA
300137474OtherRAILROAD MEDICARE
MAJ18419OtherBLUE SHIELD OF MA
MA3174212Medicaid