Basic Information
| Provider Information | |||||||||
| NPI: | 1639669260 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FORTIN | ||||||||
| FirstName: | JESSICA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7 HOLLAND WAY FL 1 | ||||||||
| Address2: | |||||||||
| City: | EXETER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038332997 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035807525 | ||||||||
| FaxNumber: | 6035807542 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 ALUMNI DR FL 2 | ||||||||
| Address2: | |||||||||
| City: | EXETER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038332128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035807525 | ||||||||
| FaxNumber: | 6035807542 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2018 | ||||||||
| LastUpdateDate: | 07/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 21216 | NH | N | Allopathic & Osteopathic Physicians | Family Medicine | 208M00000X | 21216 | NH | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.