Provider Demographics
NPI:1790734861
Name:BUERGIN, STEPHEN BENNETT (PA-C)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:BENNETT
Last Name:BUERGIN
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 1:60 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7616
Mailing Address - Country:US
Mailing Address - Phone:207-795-8260
Mailing Address - Fax:
Practice Address - Street 1:60 HIGH ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7616
Practice Address - Country:US
Practice Address - Phone:207-795-8260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2169-1363AS0400X
MEPA1405363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical