Provider Demographics
NPI:1679998116
Name:KACHURAK, JARED
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:KACHURAK
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 1:1101 SAM PERRY BLVD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4467
Mailing Address - Country:US
Mailing Address - Phone:540-372-7792
Mailing Address - Fax:540-372-2073
Practice Address - Street 1:1101 SAM PERRY BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4467
Practice Address - Country:US
Practice Address - Phone:540-372-7792
Practice Address - Fax:540-372-2073
Is Sole Proprietor?:No
Enumeration Date:2014-02-20
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical