Provider Demographics
NPI:1720024805
Name:SEMMEL, ERIC W (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:W
Last Name:SEMMEL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:C/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT
Mailing Address - Street 2:PO BOX 7291
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04243-7291
Mailing Address - Country:US
Mailing Address - Phone:207-777-8560
Mailing Address - Fax:207-777-8800
Practice Address - Street 1:900 BROADWAY
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-1900
Practice Address - Country:US
Practice Address - Phone:207-907-3300
Practice Address - Fax:207-907-1923
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA-482363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME328870099Medicaid
20Z300OtherMED A - BHMH SWING BED
AP132301OtherMED B - BHMH 200051
ME102380100Medicaid
20Z300OtherMED A - BHMH SWING BED
ME201300Medicare ID - Type UnspecifiedMEDICARE A - BHMH
ME200051Medicare ID - Type UnspecifiedMEDICARE B - BHMH
ME328870099Medicaid
AP132301OtherMED B - BHMH 200051
MEAP132303Medicare PIN