Provider Demographics
NPI:1790861896
Name:MCNEIL, JAIME CHANDLER (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:CHANDLER
Last Name:MCNEIL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:JAIME
Other - Middle Name:RYAN
Other - Last Name:CHANDLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:ONE MEDICAL CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005
Mailing Address - Country:US
Mailing Address - Phone:207-283-8800
Mailing Address - Fax:207-284-6291
Practice Address - Street 1:385 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001
Practice Address - Country:US
Practice Address - Phone:860-777-1280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003208363A00000X
MEPA1332363A00000X
MEPA301363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004675OtherCT LIC
ME1790861896Medicaid