Individual
JASON CHARLES XYNELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1195 N MAIN ST, PROVIDENCE, RI 02904-1824
(401) 331-8555
Mailing address
1195 N MAIN ST, PROVIDENCE, RI 02904-1824
(401) 331-8555
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA00501
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0021338
MEDICARE PTAN
RI
05
—
JX84601
—
RI
Enumeration date
07/19/2007
Last updated
11/30/2012
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