Provider Demographics
NPI:1093816761
Name:DJALAYER, KASRA (MD)
Entity Type:Individual
Prefix:
First Name:KASRA
Middle Name:
Last Name:DJALAYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1327
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03247-1327
Mailing Address - Country:US
Mailing Address - Phone:603-524-3211
Mailing Address - Fax:603-527-7038
Practice Address - Street 1:93 MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANCONIA
Practice Address - State:NH
Practice Address - Zip Code:03580-4801
Practice Address - Country:US
Practice Address - Phone:603-823-5502
Practice Address - Fax:603-934-4298
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038515207R00000X
MO109349207R00000X
VT042-0010327207R00000X
NH11529207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine