Provider Demographics
NPI:1528115656
Name:AIDLEN, JESSICA P (MD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:P
Last Name:AIDLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:LYNNE
Other - Last Name:PELOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:299 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1612
Mailing Address - Country:US
Mailing Address - Phone:617-219-6388
Mailing Address - Fax:617-219-6355
Practice Address - Street 1:299 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-1612
Practice Address - Country:US
Practice Address - Phone:617-219-6388
Practice Address - Fax:617-219-6355
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD12901207X00000X
MA253640207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1518921816Medicare NSC