Provider Demographics
NPI:1578791760
Name:YOUNG, AMANDA M (PA-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:M
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:M
Other - Last Name:LESSARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:492 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:ME
Mailing Address - Zip Code:04427-3273
Mailing Address - Country:US
Mailing Address - Phone:207-285-3435
Mailing Address - Fax:
Practice Address - Street 1:492 MAIN ST
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:ME
Practice Address - Zip Code:04427-3273
Practice Address - Country:US
Practice Address - Phone:207-285-3435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA001172363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME434319199Medicaid
MEMM9086Medicare PIN
ME0011559Medicare PIN