Provider Demographics
NPI:1225636947
Name:BICKFORD, SAMANTHA MARIE-DUBAY (PA-C)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MARIE-DUBAY
Last Name:BICKFORD
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 1:582 ROOSEVELT TRL
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-4904
Mailing Address - Country:US
Mailing Address - Phone:207-892-3233
Mailing Address - Fax:
Practice Address - Street 1:582 ROOSEVELT TRL
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-4904
Practice Address - Country:US
Practice Address - Phone:207-892-3233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA2522363A00000X
NC363AS0400X
NC0010-10757363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical