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Individual

DR. JASON R PETTUS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
ONE MEDICAL CENTER DR, DARTMOUTH-HITCHCOCK MEDICAL CENTER, DEPT. OF PATHOLOGY, LEBANON, NH 03756-1000
(603) 650-5000
Mailing address
ONE MEDICAL CENTER DR, DARTMOUTH-HITCHCOCK MEDICAL CENTER, DEPT. OF PATHOLOGY, LEBANON, NH 03756-1000
(603) 650-5000

Taxonomy

Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
16131
NH
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
250580
MA
390200000X
Student in an Organized Health Care Education/Training Program

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1021925
VT
05
3086997
NH
Enumeration date
04/17/2008
Last updated
09/09/2013
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