Provider Demographics
NPI:1417196577
Name:ARICH, JENNIFER K (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:ARICH
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 1:22 BRAMHALL ST
Mailing Address - Street 2:DEPT OF SURGERY
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3134
Mailing Address - Country:US
Mailing Address - Phone:207-662-4078
Mailing Address - Fax:207-662-6389
Practice Address - Street 1:22 BRAMHALL ST
Practice Address - Street 2:DEPT OF SURGERY
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3134
Practice Address - Country:US
Practice Address - Phone:207-662-4078
Practice Address - Fax:207-662-6389
Is Sole Proprietor?:No
Enumeration Date:2009-02-13
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA001152363AM0700X
MEPA1152363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0011362Medicare PIN