Provider Demographics
NPI:1871541912
Name:JOHNSON, PATRICIA A (PA-C)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
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 1:5 MEDINAH CIR
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1138
Mailing Address - Country:US
Mailing Address - Phone:207-885-9905
Mailing Address - Fax:207-396-5601
Practice Address - Street 1:96 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7133
Practice Address - Country:US
Practice Address - Phone:207-396-5611
Practice Address - Fax:207-396-5601
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA683363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEAP1388Medicare ID - Type UnspecifiedMEDICARE ID NUMBER
MEP21929Medicare UPIN
MEAP138801Medicare PIN