Provider Demographics
NPI:1366936882
Name:SZELOG, JASON (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:SZELOG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 BORTHWICK AVE STE 200E
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4184
Mailing Address - Country:US
Mailing Address - Phone:603-436-1773
Mailing Address - Fax:603-427-0655
Practice Address - Street 1:155 BORTHWICK AVE STE 200E
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4184
Practice Address - Country:US
Practice Address - Phone:603-436-1773
Practice Address - Fax:603-427-0655
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA275986207W00000X, 207R00000X
NH23619207W00000X, 207WX0107X, 174400000X
MA291178207WX0107X
MEMD26571207WX0107X, 207W00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine