Individual
JASON EDWARD DEREK SAUCEDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655
(508) 334-3452
(774) 441-7657
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
269496
MA
207RC0000X
Cardiovascular Disease Physician
Primary
269496
MA
207UN0901X
Nuclear Cardiology Physician
269496
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110121488A
—
MA
Enumeration date
05/04/2007
Last updated
06/19/2025
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