Individual
DR. VICKI ANN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
55 FRUIT ST, PALLIATIVE CARE SERVICE FND 600, BOSTON, MA 02114-2696
(617) 724-9197
(617) 724-8693
Mailing address
960 MASSACHUSETTS AVE STE 2, BOSTON, MA 02118-2690
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
156340
MA
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
Primary
156340
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0191639
—
MA
01
—
156340
TUFTS HEALTH PLAN
MA
01
—
J24683
BCBS MA
MA
Enumeration date
10/27/2005
Last updated
08/22/2025
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