Provider Demographics
NPI:1659485704
Name:PERSIN, MAUREEN C (DO)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:C
Last Name:PERSIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9353
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-9353
Mailing Address - Country:US
Mailing Address - Phone:610-866-0466
Mailing Address - Fax:610-866-1405
Practice Address - Street 1:217 W BROAD ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-5517
Practice Address - Country:US
Practice Address - Phone:610-866-0466
Practice Address - Fax:610-866-1405
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008314L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG28044Medicare UPIN
PA873503Medicare ID - Type Unspecified