Provider Demographics
NPI:1295761195
Name:HOLDER, JAIME ALLEGO (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:ALLEGO
Last Name:HOLDER
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:2139 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-2336
Mailing Address - Country:US
Mailing Address - Phone:860-257-4131
Mailing Address - Fax:860-257-4519
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:SUITE 1000
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-246-2571
Practice Address - Fax:860-246-3691
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2011-04-29
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Provider Licenses
StateLicense IDTaxonomies
NC103054363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT970002739Medicare PIN
NCP39652Medicare UPIN