Provider Demographics
NPI:1649230053
Name:GATHMAN, PATRICIA D (PA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:D
Last Name:GATHMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-6623
Mailing Address - Country:US
Mailing Address - Phone:207-872-1303
Mailing Address - Fax:207-872-1302
Practice Address - Street 1:149 NORTH ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4974
Practice Address - Country:US
Practice Address - Phone:207-872-1303
Practice Address - Fax:207-872-1302
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA287363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME154420000Medicaid
MEAP081803Medicare PIN
MEAP0818Medicare PIN
ME970015662Medicare PIN
MES56235Medicare UPIN
MEAP081801Medicare PIN
MEP00406839Medicare PIN