Provider Demographics
NPI:1871525675
Name:REDIGER, JEFFREY DON (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DON
Last Name:REDIGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-0229
Mailing Address - Country:US
Mailing Address - Phone:978-762-4888
Mailing Address - Fax:978-762-3922
Practice Address - Street 1:MCLEAN HOSPITAL SOUTHEAST LOCATION
Practice Address - Street 2:940 BELMONT STREET
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301
Practice Address - Country:US
Practice Address - Phone:508-894-8317
Practice Address - Fax:508-894-8334
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1594622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ25091OtherBCBS
MAJ25091OtherBCBS
H65441Medicare UPIN