Basic Information
| Provider Information | |||||||||
| NPI: | 1366688608 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JUNQUEIRA | ||||||||
| FirstName: | JERONIMO | ||||||||
| MiddleName: | |||||||||
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| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 RIVERS EDGE DR | ||||||||
| Address2: | APT 403 | ||||||||
| City: | MEDFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021555460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176978531 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 72 E CONCORD ST | ||||||||
| Address2: | EVANS 124 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176388000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2008 | ||||||||
| LastUpdateDate: | 11/28/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 237680 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.