Provider Demographics
NPI:1073564936
Name:FRY, PATRICIA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MARIE
Last Name:FRY
Suffix:
Gender:F
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 11390
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4004
Mailing Address - Country:US
Mailing Address - Phone:239-348-4221
Mailing Address - Fax:
Practice Address - Street 1:8340 COLLIER BLVD STE 103
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34114-3589
Practice Address - Country:US
Practice Address - Phone:239-348-4221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC50000409363A00000X
FLPA9104905363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
51-0370286OtherHEALTH NET - TRICARE/CHAMPUS
51-0370286OtherUNION LABOR LIFE INSURANCE COMPANY
P00075460OtherRAILROAD MEDICARE
DE1000027208Medicaid
51-0370286OtherGREAT-WEST HEALTHCARE
DE51-0370286OtherEASTERN SUSSEX PHYSICIANS ORGANIZATION
51-0370286OtherDEVON HEALTH SERVICES
DE1000027208Medicaid
013185023Medicare PIN