Provider Demographics
NPI:1316998107
Name:ROSENBLUM, JENNIFER LEIGH (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LEIGH
Last Name:ROSENBLUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-643-1201
Mailing Address - Fax:617-724-1201
Practice Address - Street 1:40 2ND AVE STE 300
Practice Address - Street 2:MGH WEST
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1136
Practice Address - Country:US
Practice Address - Phone:617-643-1201
Practice Address - Fax:617-243-6798
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA209839207R00000X, 207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0197629Medicaid
MAJ25140OtherBCBS MA
MA209839OtherTUFTS HEALTH PLAN
MAA34558Medicare ID - Type Unspecified
MAJ25140OtherBCBS MA