Provider Demographics
NPI:1174662407
Name:ARCHIBALD, JASON DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:DAVID
Last Name:ARCHIBALD
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Gender:M
Credentials:MD
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Mailing Address - Street 1:4 CENTENNIAL DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-7935
Mailing Address - Country:US
Mailing Address - Phone:978-531-0800
Mailing Address - Fax:978-531-2929
Practice Address - Street 1:4 CENTENNIAL DR
Practice Address - Street 2:SUITE 201
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-7935
Practice Address - Country:US
Practice Address - Phone:978-531-0800
Practice Address - Fax:978-531-2929
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2021-12-23
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Provider Licenses
StateLicense IDTaxonomies
MDP18077207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP18077Medicare UPIN