Individual
JESSICA A MANDEVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
41 MALL RD, LAHEY CLINIC, BURLINGTON, MA 01805-0001
(781) 744-2511
(781) 744-5429
Mailing address
41 MALL RD, LAHEY CLINIC, BURLINGTON, MA 01805-0001
(781) 744-2511
(781) 744-5429
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
251318
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110092756A
—
MA
Enumeration date
03/20/2008
Last updated
12/18/2012
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