Provider Demographics
NPI:1447432018
Name:SCHIMMACK, MELINDA P (PA-C)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:P
Last Name:SCHIMMACK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:
Other - Last Name:PEARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:10 HIGH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7653
Mailing Address - Country:US
Mailing Address - Phone:207-795-5710
Mailing Address - Fax:207-795-2559
Practice Address - Street 1:10 HIGH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7653
Practice Address - Country:US
Practice Address - Phone:207-795-5710
Practice Address - Fax:207-795-2559
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2607363A00000X
MEPA1188363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME001316102Medicare PIN