Provider Demographics
NPI:1790704625
Name:HEARN, WALTER N (PA-C)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:N
Last Name:HEARN
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 1:26 BARNARD LN
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-6714
Mailing Address - Country:US
Mailing Address - Phone:207-502-7074
Mailing Address - Fax:207-985-1304
Practice Address - Street 1:26 BARNARD LN
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6714
Practice Address - Country:US
Practice Address - Phone:207-502-7074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA-060363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME002421OtherANTHEM BC/BS
ME142492OtherUSHC
ME010378298OtherMACHIGONNE
ME0518560OtherCIGNA
ME295630099Medicaid
MEDO3850OtherHARVARD PILGRIM
ME080044502OtherRAILROAD MEDICARE
ME295630099OtherPRIMECARE
F31615Medicare UPIN
MEAP0439Medicare ID - Type Unspecified