Provider Demographics
NPI:1740829514
Name:MCLERNAN, JAH AUGUSTUS (CRNA)
Entity type:Individual
Prefix:
First Name:JAH
Middle Name:AUGUSTUS
Last Name:MCLERNAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:310 CONCORD AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1208
Mailing Address - Country:US
Mailing Address - Phone:508-523-9205
Mailing Address - Fax:
Practice Address - Street 1:690 CANTON ST # 204
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-2321
Practice Address - Country:US
Practice Address - Phone:339-204-9516
Practice Address - Fax:781-459-4698
Is Sole Proprietor?:No
Enumeration Date:2019-12-27
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MARN274043163WC0200X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine