Provider Demographics
NPI:1740578400
Name:MCCROSSIN, BRANDON E (PA-C)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:E
Last Name:MCCROSSIN
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:301C US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9701
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:66 BRAMHALL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3344
Practice Address - Country:US
Practice Address - Phone:207-662-3157
Practice Address - Fax:207-662-4257
Is Sole Proprietor?:No
Enumeration Date:2011-07-15
Last Update Date:2011-09-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MEPA001282363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0023268Medicare PIN