Provider Demographics
NPI:1316043565
Name:JAOUDE, JEAN (MD)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:JAOUDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:E
Other - Last Name:ABDALLAH ABOU JAOUDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:280 CHESTNUT STREET
Mailing Address - Street 2:2ND FL
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1001
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:
Practice Address - Street 1:30 CAPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-1359
Practice Address - Country:US
Practice Address - Phone:413-794-6411
Practice Address - Fax:413-794-6685
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-36734207Q00000X, 207QH0002X
MA277090207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1499905Medicaid
IA1316043565Medicaid
IAP00379208OtherRR MEDICARE
IA0499905Medicaid
IA2499905Medicaid
IA1499905Medicaid
IA2499905Medicaid