Provider Demographics
NPI:1760796494
Name:MASSIE, EMILEE A (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:EMILEE
Middle Name:A
Last Name:MASSIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:EMILEE
Other - Middle Name:
Other - Last Name:SCHROEDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:190 RIVERSIDE ST UNIT 6B
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-1073
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22 BRAMHALL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3134
Practice Address - Country:US
Practice Address - Phone:207-662-2414
Practice Address - Fax:207-662-6038
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA1843363A00000X
GA006120363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00975462OtherRAILROAD MEDICARE
GA003112781DMedicaid
GA003112781AMedicaid
GA003112781BMedicaid
GAP01112263OtherRAILROAD MEDICARE
GA003112781CMedicaid
SC1229PAMedicaid
GA003112781CMedicaid
SC1229PAMedicaid