Doctor Name: | CONNIE A JACKSON |
NPI Number: | 1902828783 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | 71138 |
Business Practice Address: | 55 Pond Ave Brookline, MA - 024457170 |
Business Phone Number: | 6172320202 |
Business Fax Number: | 6177318749 |
Mailing Address: | 82 Beacon St, CHESTNUT HILL |
State: | MA |
Postal Code: | 024671303 |
Phone Number: | 6174706843 |
Fax Number: | 6177318749 |
NPI Enumeration Date: | 07/24/2006 |
NPI Last Update Date: | 08/19/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207V00000X |
License Number: | 71138 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Obstetrics & Gynecology |
Taxonomy Specialization: | |
Taxonomy Definition: | An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |