Individual
DR. JENNIFER MOORE KICKHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
55 FRUIT STREET YAW 4, VINCENT OB/GYN SERVICE, BOSTON, MA 02114
(617) 724-6850
(617) 724-5843
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 724-6850
(617) 724-5843
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
215787
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0178861
—
MA
01
—
215787
TUFTS HEALTH PLAN
MA
01
—
J25357
BCBS MA
MA
Enumeration date
07/11/2006
Last updated
05/12/2025
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