Provider Demographics
NPI:1962416628
Name:REIDY, JENNIFER ANN (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:REIDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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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 1:55 LAKE AVE N
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655-0002
Practice Address - Country:US
Practice Address - Phone:508-334-8630
Practice Address - Fax:774-441-6710
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223107207Q00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA043024278OtherFIRST HEALTH/HCVM
MA043024278OtherGREATWEST HEALTH
MA043024278OtherCOMMONWEALTH INDEMNITY
MA115260OtherFALLON COMMUNITY HEALTH
MA96589101OtherNETWORK HEALTH PLAN
MA043024278OtherPRIVATE HEALTHCARE SYSTEM
MA1160226OtherAETNA
MA494604OtherTUFTS HEALTH PLAN
MA93380OtherCHILDREN'S MEDICAL SEC
MAAA55643OtherHARVARD PILGRIM
MA043024278OtherMULTIPLAN
MA01-04959OtherEVERCARE SENIOR CARE OP
MA043024278OtherCOMMONWEALTH INDEMNITY
MA93380OtherCHILDREN'S MEDICAL SEC