Provider Demographics
NPI:1619963840
Name:FURLONG, PATRICK J (PA-C)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:FURLONG
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:301C US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9701
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:5 BUCKNAM RD
Practice Address - Street 2:SUITE 1D
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1392
Practice Address - Country:US
Practice Address - Phone:207-775-1551
Practice Address - Fax:207-775-1552
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2012-04-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MEPA-656363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEAP113503Medicare PIN
MEAP113501Medicare PIN
MEAP113502Medicare PIN
MES92871Medicare UPIN