Basic Information
| Provider Information | |||||||||
| NPI: | 1649373986 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRAIMON | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | ONE ESSEX CENTER DRIVE | ||||||||
| Address2: | LAHEY CLINIC | ||||||||
| City: | PEABODY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019602901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9785384674 | ||||||||
| FaxNumber: | 9785384712 | ||||||||
| Practice Location | |||||||||
| Address1: | ONE ESSEX CENTER DRIVE | ||||||||
| Address2: | LAHEY CLINIC | ||||||||
| City: | PEABODY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019602901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9789776336 | ||||||||
| FaxNumber: | 9785384712 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2006 | ||||||||
| LastUpdateDate: | 09/27/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 77394 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 110059748A | 05 | MA | MEDICAID |