Provider Demographics
NPI:1285659599
Name:CHRETIEN, JASON MICHAEL (PA)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:MICHAEL
Last Name:CHRETIEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:ME
Mailing Address - Zip Code:04530-2713
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:219 CAPITOL ST
Practice Address - Street 2:SUITE 2
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-6235
Practice Address - Country:US
Practice Address - Phone:207-529-5005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA-863363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical