Healthcare Provider Details

I. General information

NPI: 1659036333
Provider Name (Legal Business Name): JAMIE KAZAR PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 10/13/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

798 ROUTE 302
BERLIN VT
05641-2305
US

IV. Provider business mailing address

10 FERRY ST STE 302
CONCORD NH
03301-5081
US

V. Phone/Fax

Practice location:
  • Phone: 802-744-0138
  • Fax: 802-622-0836
Mailing address:
  • Phone: 603-526-4635
  • Fax: 603-526-2151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number055.0031592
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4198
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: