Provider Demographics
NPI:1205812666
Name:URSO, JASON S (REGISTERED PA)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:S
Last Name:URSO
Suffix:
Gender:M
Credentials:REGISTERED PA
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 2000
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28026-2000
Mailing Address - Country:US
Mailing Address - Phone:704-403-1430
Mailing Address - Fax:704-403-1158
Practice Address - Street 1:920 CHURCH ST N
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2927
Practice Address - Country:US
Practice Address - Phone:704-403-1430
Practice Address - Fax:704-403-1158
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02122363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5489L1OtherLEGACY
NY5489L1OtherLEGACY