Individual
JESSIE H MACVICAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
110 LIBERTY ST, BROCKTON, MA 02301-5521
(508) 894-0400
(508) 565-0157
Mailing address
110 LIBERTY ST, BROCKTON, MA 02301-5521
(508) 894-0400
(508) 565-0157
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
206882
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0161730
—
MA
Enumeration date
11/08/2005
Last updated
09/20/2013
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