Provider Demographics
NPI:1962514356
Name:MAHAN, WILLIAM GUY (PA-C)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:GUY
Last Name:MAHAN
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 1:10 WAYMAN LN
Mailing Address - Street 2:
Mailing Address - City:BAR HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04609-1625
Mailing Address - Country:US
Mailing Address - Phone:207-288-5082
Mailing Address - Fax:207-288-8642
Practice Address - Street 1:10 WAYMAN LN
Practice Address - Street 2:
Practice Address - City:BAR HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04609-1625
Practice Address - Country:US
Practice Address - Phone:207-288-5081
Practice Address - Fax:207-288-8642
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA385363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1023800100Medicaid
MEAP0611OtherMEDICARE B - MDIH
ME201300Medicare ID - Type UnspecifiedMEDICARE A - BHMH
MEAP0611OtherMEDICARE B - MDIH
MEAP061101Medicare PIN
ME200051Medicare ID - Type UnspecifiedMEDICARE B - BHMH