Individual
JESSICA SMALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1611 CAMBRIDGE ST, CAMBRIDGE, MA 02138-4302
(617) 661-5500
(617) 661-5136
Mailing address
1611 CAMBRIDGE ST, CAMBRIDGE, MA 02138-4302
(617) 661-5500
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
214185
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2115131
—
MA
01
—
214185
TUFTS
MA
01
—
J25619
BLUE CROSS LEGACY PROV#
MA
Enumeration date
03/30/2006
Last updated
03/07/2021
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