Provider Demographics
NPI:1821051046
Name:SALISBURY, ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:SALISBURY
Suffix:
Gender:F
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 1:6 CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:ME
Mailing Address - Zip Code:04071-6559
Mailing Address - Country:US
Mailing Address - Phone:207-653-1749
Mailing Address - Fax:
Practice Address - Street 1:144 STATE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3795
Practice Address - Country:US
Practice Address - Phone:207-879-3464
Practice Address - Fax:207-400-8620
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA-281363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME265560099Medicaid