Provider Demographics
NPI:1114358959
Name:O'HARA, JAY
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:O'HARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 HILLVIEW RD
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:NY
Mailing Address - Zip Code:14883-9685
Mailing Address - Country:US
Mailing Address - Phone:505-235-7076
Mailing Address - Fax:
Practice Address - Street 1:1 JARRETT WHITE RD
Practice Address - Street 2:
Practice Address - City:TRIPLER ARMY MEDICAL CENTER
Practice Address - State:HI
Practice Address - Zip Code:96859-5001
Practice Address - Country:US
Practice Address - Phone:505-235-7076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-04
Last Update Date:2024-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant