Provider Demographics
NPI:1417918665
Name:MCGLEW, SHAWN (PA-C)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:MCGLEW
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 1:442 CIVIC CENTER DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-8572
Mailing Address - Country:US
Mailing Address - Phone:207-622-6319
Mailing Address - Fax:207-622-6654
Practice Address - Street 1:442 CIVIC CENTER DR
Practice Address - Street 2:SUITE 150
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-8572
Practice Address - Country:US
Practice Address - Phone:207-622-6319
Practice Address - Fax:207-622-6654
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA413363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME154420000Medicaid
ME154420000Medicaid
MEAP0799Medicare ID - Type Unspecified