Provider Demographics
NPI:1700012325
Name:UNDERHILL, JONATHAN K (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:K
Last Name:UNDERHILL
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 1:1 DEACONESS RD
Mailing Address - Street 2:CLINICAL CENTER ROOM 303
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5321
Mailing Address - Country:US
Mailing Address - Phone:617-754-2517
Mailing Address - Fax:617-754-2651
Practice Address - Street 1:1 DEACONESS RD
Practice Address - Street 2:CLINICAL CENTER ROOM 303
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5321
Practice Address - Country:US
Practice Address - Phone:617-754-2517
Practice Address - Fax:617-754-2651
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA452363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant