Provider Demographics
NPI:1427338698
Name:MARTIN, ANTHONY S (PA)
Entity type:Individual
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First Name:ANTHONY
Middle Name:S
Last Name:MARTIN
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Gender:M
Credentials:PA
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Mailing Address - Street 1:180 CHURCH HILL RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LEEDS
Mailing Address - State:ME
Mailing Address - Zip Code:04263-3418
Mailing Address - Country:US
Mailing Address - Phone:207-524-3501
Mailing Address - Fax:207-524-2093
Practice Address - Street 1:11 ACADEMY RD
Practice Address - Street 2:
Practice Address - City:MONMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04259-7035
Practice Address - Country:US
Practice Address - Phone:207-524-3501
Practice Address - Fax:207-933-9645
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2021-06-25
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Provider Licenses
StateLicense IDTaxonomies
MEPA1399363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ020529Medicaid
ME1427338698Medicaid
ME1427338698Medicaid