Provider Demographics
NPI:1679845630
Name:GOTT, JONATHAN ALLAN (PA-C)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ALLAN
Last Name:GOTT
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 458
Mailing Address - Street 2:207 STAGE ROAD
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NH
Mailing Address - Zip Code:03841-0458
Mailing Address - Country:US
Mailing Address - Phone:603-329-5222
Mailing Address - Fax:
Practice Address - Street 1:207 STAGE RD
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NH
Practice Address - Zip Code:03841-2224
Practice Address - Country:US
Practice Address - Phone:603-329-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0874363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHF19910Medicare UPIN