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General NPI Number Information
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NPI Number | 1366936882
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Entity Type | Individual
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Provider Name | JASON SZELOG MD
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Gender | Male
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Dates
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Enumeration Date | 06/18/2018
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 155 BORTHWICK AVE STE 200E
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City | PORTSMOUTH
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State | NH
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Zip | 03801-4184
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Country | US
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Telephone | 603-436-1773
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Fax | 603-427-0655
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Provider Business Mailing Address
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Address Line | 155 BORTHWICK AVE STE 200E
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City | PORTSMOUTH
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State | NH
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Zip | 03801-4184
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Country | US
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Telephone | 603-436-1773
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Fax | 603-427-0655
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 275986
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 23619
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License Number State | NH
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Taxonomy #3
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number | 291178
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number | 23619
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License Number State | NH
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Taxonomy #5
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number | MD26571
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License Number State | ME
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Taxonomy #6
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD26571
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License Number State | ME
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Taxonomy #7
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 23619
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License Number State | NH
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Taxonomy #8
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD26571
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License Number State | ME
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Taxonomy #9
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 275986
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License Number State | MA
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