Provider Demographics
NPI:1588616130
Name:CHAMBERLAIN, JAY R (PA-C)
Entity type:Individual
Prefix:MR
First Name:JAY
Middle Name:R
Last Name:CHAMBERLAIN
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3 BLACKBIRD CT
Mailing Address - Street 2:
Mailing Address - City:DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-5303
Mailing Address - Country:US
Mailing Address - Phone:508-998-6000
Mailing Address - Fax:
Practice Address - Street 1:172 KINSLEY ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3648
Practice Address - Country:US
Practice Address - Phone:603-882-3000
Practice Address - Fax:603-889-3774
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH1110363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S28255Medicare UPIN