Healthcare Provider Details

I. General information

NPI: 1295761195
Provider Name (Legal Business Name): JAIME ALLEGO HOLDER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 04/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SEYMOUR ST SUITE 1000
HARTFORD CT
06106-5501
US

IV. Provider business mailing address

2139 SILAS DEANE HWY
ROCKY HILL CT
06067-2336
US

V. Phone/Fax

Practice location:
  • Phone: 860-246-2571
  • Fax: 860-246-3691
Mailing address:
  • Phone: 860-257-4131
  • Fax: 860-257-4519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number103054
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: