Provider Demographics
NPI:1356308373
Name:WRIGHT, MARK S (PA-C)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ENTERPRISE DR
Mailing Address - Street 2:STE 100
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-7894
Mailing Address - Country:US
Mailing Address - Phone:207-621-8700
Mailing Address - Fax:207-621-8701
Practice Address - Street 1:15 ENTERPRISE DR
Practice Address - Street 2:STE 100
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-7894
Practice Address - Country:US
Practice Address - Phone:207-621-8700
Practice Address - Fax:207-621-8701
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY004272-1363AS0400X
MEPA-795363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME434193399Medicaid
ME434193399Medicaid
MEAP238801Medicare PIN
NYS27912Medicare UPIN
NYPA1042Medicare ID - Type Unspecified