Provider Demographics
NPI:1457504532
Name:MCCOSH, KELLY ERIN (PA-C)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ERIN
Last Name:MCCOSH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:76 HIGH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7649
Mailing Address - Country:US
Mailing Address - Phone:207-795-5544
Mailing Address - Fax:207-795-5645
Practice Address - Street 1:76 HIGH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7649
Practice Address - Country:US
Practice Address - Phone:207-795-5544
Practice Address - Fax:207-795-5645
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2012-12-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MEPA1361363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant