Individual
DR. JESSICA L. FEWKES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
243 CHARLES ST, BOSTON, MA 02114-3002
(617) 573-4102
Mailing address
243 CHARLES ST, BOSTON, MA 02114-3002
(617) 573-4102
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
50939
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6172903
—
MA
Enumeration date
10/31/2005
Last updated
11/07/2011
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