Provider Demographics
NPI:1730140104
Name:DORAN, JASON D (PA-C)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:D
Last Name:DORAN
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 1:7 MARSH BROOK DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SOMERSWORTH
Mailing Address - State:NH
Mailing Address - Zip Code:03878-6523
Mailing Address - Country:US
Mailing Address - Phone:603-742-2007
Mailing Address - Fax:603-749-4605
Practice Address - Street 1:7 MARSH BROOK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SOMERSWORTH
Practice Address - State:NH
Practice Address - Zip Code:03878-6523
Practice Address - Country:US
Practice Address - Phone:603-742-2007
Practice Address - Fax:603-749-4605
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0528 P363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3079297Medicaid
AP2252Medicare PIN