Provider Demographics
NPI:1750493417
Name:CORRIGAN, MARY E (PNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:CORRIGAN
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Gender:F
Credentials:PNP
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Mailing Address - Street 1:301 US ROUTE 1
Mailing Address - Street 2:BUILDING C
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7609
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:887 CONGRESS ST
Practice Address - Street 2:SUITE 320
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3100
Practice Address - Country:US
Practice Address - Phone:207-662-5522
Practice Address - Fax:207-662-5527
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-01-04
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Provider Licenses
StateLicense IDTaxonomies
MER028536363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME290110099Medicaid
NH30344975Medicaid
ME290110099Medicaid
MEP42189Medicare UPIN