Provider Demographics
NPI:1639558497
Name:POIRIER, JARROD
Entity Type:Individual
Prefix:
First Name:JARROD
Middle Name:
Last Name:POIRIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 STANDISH RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:MA
Mailing Address - Zip Code:02056-1402
Mailing Address - Country:US
Mailing Address - Phone:508-528-2054
Mailing Address - Fax:
Practice Address - Street 1:391 NORWICH WESTERLY RD
Practice Address - Street 2:
Practice Address - City:NORTH STONINGTON
Practice Address - State:CT
Practice Address - Zip Code:06359-9992
Practice Address - Country:US
Practice Address - Phone:860-535-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical