Provider Demographics
NPI:1750887329
Name:DORE, JONATHAN THOMAS (PA-C)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:THOMAS
Last Name:DORE
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:711 TROY SCHENECTADY RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2461
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:939 ROUTE 146 STE 700
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3662
Practice Address - Country:US
Practice Address - Phone:518-383-0891
Practice Address - Fax:518-383-1662
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2019-03-21
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Provider Licenses
StateLicense IDTaxonomies
363A00000X
NY022013363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant