Provider Demographics
NPI:1609212018
Name:MCCOLGAN, JENNIFER KELLEY (PA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KELLEY
Last Name:MCCOLGAN
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:18 DEBBIE CT
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-2377
Mailing Address - Country:US
Mailing Address - Phone:802-345-5050
Mailing Address - Fax:
Practice Address - Street 1:450 BROOKLINE AVE
Practice Address - Street 2:DANA 2, HEAD AND NECK ONCOLOGY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5418
Practice Address - Country:US
Practice Address - Phone:617-632-3090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-13
Last Update Date:2016-02-25
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant