Basic Information
| Provider Information | |||||||||
| NPI: | 1871557520 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JACKSON | ||||||||
| FirstName: | ALAN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9 INDUSTRIAL RD | ||||||||
| Address2: | STE 5 | ||||||||
| City: | MILFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017573736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084731480 | ||||||||
| FaxNumber: | 5084732709 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 COMMERCE DR | ||||||||
| Address2: | |||||||||
| City: | NORTHBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015341425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087312575 | ||||||||
| FaxNumber: | 0826606085 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2006 | ||||||||
| LastUpdateDate: | 01/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 50900 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0400963 | 01 | EVERCARE | OTHER | AA1209 | 01 | HARVARD PILGRIM HEALTHCAR | OTHER | J02952 | 01 | BLUE CARE ELECT | OTHER | J02952 | 01 | MEDICARE B | OTHER | 043058466 | 01 | HEALTHCARE VALUE MGMT | OTHER | 110048763 | 01 | RAILROAD MEDICARE | OTHER | 6174345 | 05 | MA | MEDICAID | 934961 | 01 | FIRST HEALTH | OTHER | 042472266 | 01 | PRIVATE HEALTHCARE SYSTEM | OTHER | J02952 | 01 | BLUE SHIELD HMO BLUE | OTHER | 042472266 | 01 | ONE HEALTH PLAN | OTHER | 4034907 | 01 | AETNA US HEALTHCARE | OTHER | 8465722 | 01 | CIGNA HEALTH PLAN | OTHER | 8758 | 01 | FALLON COMMUNITY HEALTH P | OTHER | 29186 | 01 | CHILDRENS MED SEC PLAN | OTHER | 29186 | 01 | HEALTHY START | OTHER | 784239 | 01 | MVP HEALTH CARE | OTHER | J02952 | 01 | BLUE SHIELD INDEMNITY | OTHER |