Provider Demographics
NPI:1720045032
Name:RIMBACH, MAURA LEE (PAC)
Entity Type:Individual
Prefix:MS
First Name:MAURA
Middle Name:LEE
Last Name:RIMBACH
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 ROUTE 1 BYPASS
Mailing Address - Street 2:SPORTSMEDICINE ATLANTIC ORTHOPEDICS, PA
Mailing Address - City:PORTSMUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801
Mailing Address - Country:US
Mailing Address - Phone:603-431-1121
Mailing Address - Fax:
Practice Address - Street 1:150 ROUTE 1 BYPASS
Practice Address - Street 2:SPORTSMEDICINE ATLANTIC ORTHOPEDICS, PA
Practice Address - City:PORTSMUTH
Practice Address - State:NH
Practice Address - Zip Code:03801
Practice Address - Country:US
Practice Address - Phone:603-431-1121
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0589363A00000X
MEPA001046363A00000X
MA1753363A00000X
IL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P75115Medicare UPIN
AP2082Medicare ID - Type Unspecified