Provider Demographics
NPI:1699076927
Name:FLEMING, JENNIE E (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JENNIE
Middle Name:E
Last Name:FLEMING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:508-334-1977
Practice Address - Street 1:119 BELMONT STREET
Practice Address - Street 2:NEONATOLOGY
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2903
Practice Address - Country:US
Practice Address - Phone:508-334-6206
Practice Address - Fax:508-334-6083
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA890363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110117781AMedicaid
MAS400339929OtherMEDICARE