Provider Demographics
NPI:1427288810
Name:BUTTERFIELD, TAYLOR C (PA-C)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:C
Last Name:BUTTERFIELD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:M
Other - Last Name:CARLETON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:190 STETSON RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-7813
Mailing Address - Country:US
Mailing Address - Phone:207-784-7388
Mailing Address - Fax:207-795-2043
Practice Address - Street 1:190 STETSON RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-7813
Practice Address - Country:US
Practice Address - Phone:207-784-7388
Practice Address - Fax:207-795-2043
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA1401363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMDA0236Medicaid
8EH489Medicare PIN