Individual
ADAEZE JENNIFER EZEOFOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
55 FRUIT ST, BOSTON, MA 02114-2696
(617) 726-2000
Mailing address
205 REVERE BEACH PKWY UNIT 636, REVERE, MA 02151-5491
(773) 980-0830
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
E216-0109-3807
DRIVER'S LICENSE
IL
Enumeration date
05/10/2021
Last updated
05/10/2021
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