Provider Demographics
NPI:1285615641
Name:KNOTT, JEFFERSON (PA)
Entity type:Individual
Prefix:MR
First Name:JEFFERSON
Middle Name:
Last Name:KNOTT
Suffix:
Gender:M
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:330 BROOKLINE AVE
Mailing Address - Street 2:BIDMC SHAPIRO 2 C/O DR. PAUL GLAZER
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5400
Mailing Address - Country:US
Mailing Address - Phone:617-667-2225
Mailing Address - Fax:617-667-2233
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:BIDMC SHAPIRO 2 C/O DR. PAUL GLAZER
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-667-2225
Practice Address - Fax:617-667-2233
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Not Answered363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q53292Medicare UPIN
AP2485Medicare ID - Type Unspecified