Provider Demographics
NPI:1972123289
Name:DIAS, JARED ANTHONY (PA-C)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:ANTHONY
Last Name:DIAS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 DEVENS ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01151-2304
Mailing Address - Country:US
Mailing Address - Phone:413-237-8863
Mailing Address - Fax:
Practice Address - Street 1:52 DEVENS ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01151-2304
Practice Address - Country:US
Practice Address - Phone:413-237-8863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant