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General NPI Number Information
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NPI Number | 1295761195
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Entity Type | Individual
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Provider Name | JAIME ALLEGO HOLDER PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 04/29/2011
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Provider Practice Location Address
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Address Line | 85 SEYMOUR ST SUITE 1000
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City | HARTFORD
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State | CT
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Zip | 06106-5501
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Country | US
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Telephone | 860-246-2571
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Fax | 860-246-3691
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Provider Business Mailing Address
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Address Line | 2139 SILAS DEANE HWY
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City | ROCKY HILL
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State | CT
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Zip | 06067-2336
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Country | US
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Telephone | 860-257-4131
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Fax | 860-257-4519
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 103054
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License Number State | NC
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