Provider Demographics
NPI:1215925011
Name:KELLOGG, JEFFREY J (PA, MBA)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:J
Last Name:KELLOGG
Suffix:
Gender:M
Credentials:PA, MBA
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Mailing Address - Street 1:26 STORMVIEW RD
Mailing Address - Street 2:
Mailing Address - City:LANESBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01237-9732
Mailing Address - Country:US
Mailing Address - Phone:413-441-1921
Mailing Address - Fax:
Practice Address - Street 1:20 WILLIAMSTOWN RD
Practice Address - Street 2:
Practice Address - City:LANESBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01237-9548
Practice Address - Country:US
Practice Address - Phone:413-455-6800
Practice Address - Fax:833-948-3572
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1520363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAQ19047Medicare UPIN