Provider Demographics
NPI:1134858418
Name:STEPHANSKY, JASON ROBERT (PA)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:ROBERT
Last Name:STEPHANSKY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1130 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WHITMAN
Mailing Address - State:MA
Mailing Address - Zip Code:02382-1236
Mailing Address - Country:US
Mailing Address - Phone:781-710-0072
Mailing Address - Fax:
Practice Address - Street 1:335 BRIGHTON AVE STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2362
Practice Address - Country:US
Practice Address - Phone:207-662-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEPA2392OtherBOARD OF LICENSURE IN MEDICINE