Jeffrey Paul Fennelly, MD
Individual provider Active NPI General Practice Physician · Ayer, MA
NPI 1760770531 · NPPES record last updated May 17, 2021
Key facts
- NPI
- 1760770531
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Physician 208D00000X
- License
- 301389 (NY)
- Practice address
- 42 Patton Rd
Ayer, MA 01434-3802 - Phone
- (781) 555-1212
- NPI assigned
- Jul 14, 2011
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 301389 | NY | MD | Acute Care Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 301389 | NY | Yes |
Addresses
Primary practice location
42 Patton Rd
Ayer, MA 01434-3802
Mailing address
42 Patton Rd
Ayer, MA 01434-3802
Phone (781) 555-1212
Other providers in Ayer, MA
- Brian C Dressel
- Christopher A Duffey
- Michele R Dunn
- Essent Healthcare - Ayer, Inc.
- Federal Medical Center Devens
- Sally Floyd
- Matthew Foley
- Darlene Gaibor
- Gary Crbonello
- Zoe Ann Gillis
All providers in Ayer, MA · General Practice Physician in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 17, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.