Provider Demographics
NPI:1316068497
Name:JACKSON, WILLIAM P (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:P
Last Name:JACKSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:ADVANTAGECARE PHYSICIANS, PC
Mailing Address - Street 2:55 WATER STREET 2ND FLOOR CRED DEPT
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10041-0004
Mailing Address - Country:US
Mailing Address - Phone:646-680-2888
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:TUFTS-NEW ENGLAND MEDICAL CENTER
Practice Address - Street 2:750 WASHINGTON STREET
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116
Practice Address - Country:US
Practice Address - Phone:617-636-4720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2021-01-26
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Provider Licenses
StateLicense IDTaxonomies
MA216300207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine