Individual
DR. JOSEPH ALEXANDER JACKSON IV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1493 CAMBRIDGE ST, STATION LANDING/CCAD, CAMBRIDGE, MA 02139-1047
(781) 306-8655
(781) 306-8655
Mailing address
1493 CAMBRIDGE ST, STATION LANDING/CCAD, CAMBRIDGE, MA 02139-1047
(781) 306-8655
(781) 306-8655
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
217374
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2020203
—
MA
01
—
J26769
BCBS PROVIDER
MA
Enumeration date
01/28/2006
Last updated
07/09/2007
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