Provider Demographics
NPI:1124288196
Name:COLALUCA, MATTHEW K (PA-C)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:K
Last Name:COLALUCA
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:PO BOX 274
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:ME
Mailing Address - Zip Code:04918
Mailing Address - Country:US
Mailing Address - Phone:207-495-3323
Mailing Address - Fax:207-495-3353
Practice Address - Street 1:4 CLEMENT WAY
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:ME
Practice Address - Zip Code:04917
Practice Address - Country:US
Practice Address - Phone:207-495-3323
Practice Address - Fax:207-495-3353
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA001128363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0006692Medicare PIN