Provider Demographics
NPI:1679582126
Name:GUPPY, ANDREW (PA)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:GUPPY
Suffix:
Gender:M
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:PO BOX 921
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-0921
Mailing Address - Country:US
Mailing Address - Phone:207-942-7650
Mailing Address - Fax:207-990-5586
Practice Address - Street 1:775 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WINTERPORT
Practice Address - State:ME
Practice Address - Zip Code:04496
Practice Address - Country:US
Practice Address - Phone:207-223-5074
Practice Address - Fax:207-223-5953
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA371363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME276740099Medicaid
MEAP1645Medicare ID - Type Unspecified
ME276740099Medicaid