Provider Demographics
NPI:1508832049
Name:SOULE, MARTHA C (PA-C)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:C
Last Name:SOULE
Suffix:
Gender:F
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 1:263 WATER ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-4609
Mailing Address - Country:US
Mailing Address - Phone:207-623-2977
Mailing Address - Fax:207-626-9374
Practice Address - Street 1:263 WATER ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-4609
Practice Address - Country:US
Practice Address - Phone:207-623-2977
Practice Address - Fax:207-626-9374
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA239363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME240710099Medicaid
ME240710099Medicaid
MEP15441Medicare UPIN
MEAP132702Medicare PIN