Provider Demographics
NPI:1598706541
Name:JACKSON, VERA E (MD)
Entity type:Individual
Prefix:DR
First Name:VERA
Middle Name:E
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VERA
Other - Middle Name:
Other - Last Name:ZADINOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:178 COUNTY ST
Mailing Address - Street 2:#1
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-3636
Mailing Address - Country:US
Mailing Address - Phone:508-222-4423
Mailing Address - Fax:
Practice Address - Street 1:200 MAY ST
Practice Address - Street 2:
Practice Address - City:SOUTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-5520
Practice Address - Country:US
Practice Address - Phone:508-838-2212
Practice Address - Fax:508-838-2200
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA39571208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
A30179Medicare UPIN