Provider Demographics
NPI:1912917774
Name:MARCHILDON, MICHELE (PA)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:MARCHILDON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BUCKNAM RD STE 2C
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1209
Mailing Address - Country:US
Mailing Address - Phone:207-781-1500
Mailing Address - Fax:
Practice Address - Street 1:5 BUCKNAM RD STE 2
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1392
Practice Address - Country:US
Practice Address - Phone:207-781-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA680363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME276830099Medicaid
ME276830099Medicaid
MEP13109Medicare UPIN