Provider Demographics
NPI:1871557520
Name:JACKSON, ALAN M (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:M
Last Name:JACKSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9 INDUSTRIAL RD
Mailing Address - Street 2:STE 5
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-3736
Mailing Address - Country:US
Mailing Address - Phone:508-473-1480
Mailing Address - Fax:508-473-2709
Practice Address - Street 1:200 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:NORTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01534-1425
Practice Address - Country:US
Practice Address - Phone:508-731-2575
Practice Address - Fax:082-660-6085
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2021-01-08
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Provider Licenses
StateLicense IDTaxonomies
MA50900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0400963OtherEVERCARE
AA1209OtherHARVARD PILGRIM HEALTHCAR
J02952OtherBLUE CARE ELECT
J02952OtherMEDICARE B
043058466OtherHEALTHCARE VALUE MGMT
110048763OtherRAILROAD MEDICARE
MA6174345Medicaid
934961OtherFIRST HEALTH
042472266OtherPRIVATE HEALTHCARE SYSTEM
J02952OtherBLUE SHIELD HMO BLUE
042472266OtherONE HEALTH PLAN
4034907OtherAETNA US HEALTHCARE
8465722OtherCIGNA HEALTH PLAN
8758OtherFALLON COMMUNITY HEALTH P
29186OtherCHILDRENS MED SEC PLAN
29186OtherHEALTHY START
784239OtherMVP HEALTH CARE
J02952OtherBLUE SHIELD INDEMNITY
29186OtherHEALTHY START
MAJ02952Medicare ID - Type Unspecified