Individual
MARIANNE JACKSON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
133 PLEASANT ST, BERLIN, NH 03570-2006
(603) 752-2040
(603) 752-7797
Mailing address
133 PLEASANT ST, BERLIN, NH 03570-2006
(603) 752-2040
(603) 752-7797
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
6864
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0100920Y0NH02
ANTHEM BC/BS
NH
05
—
30203596
—
NH
01
—
5830418
AETNA GROUP
—
01
—
6236954
CIGNA HEALTHCARE
NH
01
—
POOO91565
RAILROAD MEDICARE
—
Enumeration date
08/11/2005
Last updated
03/07/2023
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