Individual
DR. JEREMY T AIDLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 LAKE AVE N, DIVISION OF PEDIATRIC SURGERY, WORCESTER, MA 01655-0002
(508) 856-2128
(774) 443-2043
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
2086S0120X
Pediatric Surgery Physician
Primary
212781
MA
2086S0120X
Pediatric Surgery Physician
MD12711
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110080669A
—
MA
Enumeration date
05/12/2008
Last updated
11/18/2020
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