Basic Information
| Provider Information | |||||||||
| NPI: | 1316974165 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PLOUFFE | ||||||||
| FirstName: | JODIE | ||||||||
| MiddleName: | XAVIER | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 MILL RD STE 180 | ||||||||
| Address2: | |||||||||
| City: | FAIRHAVEN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027195255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089732000 | ||||||||
| FaxNumber: | 5089732001 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 ROSEBROOK WAY | ||||||||
| Address2: | |||||||||
| City: | WAREHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 025711138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5082734900 | ||||||||
| FaxNumber: | 5082734901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 04/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | PA1648 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.