Provider Demographics
NPI:1437413374
Name:PELLETIER, JON (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:
Last Name:PELLETIER
Suffix:
Gender:M
Credentials:PA-C
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 655
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-0655
Mailing Address - Country:US
Mailing Address - Phone:603-778-7975
Mailing Address - Fax:
Practice Address - Street 1:3 ALUMNI DR
Practice Address - Street 2:STE 301
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-2119
Practice Address - Country:US
Practice Address - Phone:603-778-7975
Practice Address - Fax:603-778-7964
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0942363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical