Provider Demographics
NPI:1699746453
Name:HEDLUND, JACQUELYN A (MD)
Entity type:Individual
Prefix:DR
First Name:JACQUELYN
Middle Name:A
Last Name:HEDLUND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 911
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05302
Mailing Address - Country:US
Mailing Address - Phone:207-396-7600
Mailing Address - Fax:207-396-7986
Practice Address - Street 1:100 CAMPUS DRIVE
Practice Address - Street 2:SUITE 108
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9308
Practice Address - Country:US
Practice Address - Phone:207-396-7600
Practice Address - Fax:207-396-7986
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME13509207RH0003X, 207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME5656679OtherAETNA
ME6628849OtherCIGNA
ME2017782OtherAETNA HMO
ME030520OtherANTHEM BCBS
ME288720099Medicaid
ME5656679OtherAETNA
ME6628849OtherCIGNA
MEPX9149Medicare PIN