Provider Demographics
NPI:1376970350
Name:MACADAM, ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:MACADAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:SANFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1 WALLACE BASHAW WAY STE 1002
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-3876
Mailing Address - Country:US
Mailing Address - Phone:978-255-2612
Mailing Address - Fax:
Practice Address - Street 1:1 WALLACE BASHAW WAY STE 1002
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3876
Practice Address - Country:US
Practice Address - Phone:978-255-2612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-04
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1645363A00000X
NY016942363AM0700X
MAPA101188363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical