Provider Demographics
NPI:1467498543
Name:MITCHELL, RAYMOND J (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:J
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1029
Mailing Address - Street 2:
Mailing Address - City:BLUE HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04614
Mailing Address - Country:US
Mailing Address - Phone:207-374-2836
Mailing Address - Fax:207-374-2805
Practice Address - Street 1:57 WATER ST.
Practice Address - Street 2:
Practice Address - City:BLUE HILL
Practice Address - State:ME
Practice Address - Zip Code:04614
Practice Address - Country:US
Practice Address - Phone:207-374-3911
Practice Address - Fax:207-374-3986
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA-649363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME279020099Medicaid
ME279020099Medicaid
MEAP139601Medicare PIN
MEAP1396Medicare ID - Type UnspecifiedMEDICARE - PERS