Pettus, Jason R
Pettus, Jason R is an individual health care provider with primary practice located at One Medical Center Dr Dartmouth-Hitchcock Medical Center, Dept. Of Pathology, Lebanon NH 03756-1000. He recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology. Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology is his primary health care specialty. Pettus, Jason R can be contacted via phone (603) 650-5000.Contact Information
Primary practice address
One Medical Center Dr Dartmouth-Hitchcock Medical Center, Dept. Of Pathology
Lebanon NH 03756-1000
Phone: (603) 650-5000
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Student, Health Care / Student in an Organized Health Care Education/Training Program | 390200000X | ||
| Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology | 207ZP0102X | 250580 | Massachusetts |
| Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology | 207ZP0102X | 16131 | New Hampshire |
Profile Details
| NPI number | 1841464120 |
|---|---|
| LBN Legal business name | Pettus, Jason R |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 17th, 2008 |
| Last updated | Sep 9th, 2013 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1841464120 | NPPES |
| Vermont | MEDICAID | 1021925 | |
| Vermont | MEDICAID | 3086997 |
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