Provider Demographics
NPI:1467496414
Name:ANDERSON, ELIZABETH K (PA-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:K
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELISABETH
Other - Middle Name:K
Other - Last Name:CLINTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:49 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-8926
Mailing Address - Country:US
Mailing Address - Phone:207-885-4479
Mailing Address - Fax:207-883-2586
Practice Address - Street 1:49 SPRING ST
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8926
Practice Address - Country:US
Practice Address - Phone:207-885-4479
Practice Address - Fax:207-883-2586
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA-832363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME404850099Medicaid
MES30199Medicare UPIN
ME404850099Medicaid
MEP00474277Medicare PIN
MEAP2146Medicare PIN