Individual
JENNIFER FANTASIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
33 KENDALL ST, WORCESTER, MA 01605-2726
(083) 348-7655
(508) 334-9477
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
LP03299
RI
208800000X
Urology Physician
Primary
283649
MA
Other
Enumeration date
05/13/2015
Last updated
10/27/2020
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