Provider Demographics
NPI:1679564207
Name:JUPITER, JESSE BERNARD (MD)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:BERNARD
Last Name:JUPITER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-4700
Mailing Address - Fax:617-724-8532
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:YAW 2162 ORTHOPAEDIC ASSOCIATES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-5100
Practice Address - Fax:617-724-8532
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2012-09-07
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Provider Licenses
StateLicense IDTaxonomies
MA44284207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA044284OtherTUFTS HEALTH PLAN
MA2069563Medicaid
MAM09942OtherBCBS MA
MAM09942OtherBCBS MA
A67062Medicare UPIN