Basic Information
| Provider Information | |||||||||
| NPI: | 1639499528 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERWICK | ||||||||
| FirstName: | JESSICA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 DUNSTER RD UNIT 2 | ||||||||
| Address2: | |||||||||
| City: | JAMAICA PLAIN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021302703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7815885481 | ||||||||
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| Practice Location | |||||||||
| Address1: | 55 FRUIT STREET | ||||||||
| Address2: | BLK 1500 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177243874 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2010 | ||||||||
| LastUpdateDate: | 06/19/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 244707 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.