Provider Demographics
NPI:1821368895
Name:FORTIN, MARIA ANNE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:ANNE
Last Name:FORTIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:ANNE
Other - Last Name:LINDHOLM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1439 E CONE BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-4533
Mailing Address - Country:US
Mailing Address - Phone:833-904-2273
Mailing Address - Fax:
Practice Address - Street 1:1439 E CONE BLVD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-4533
Practice Address - Country:US
Practice Address - Phone:833-904-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-03271363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8101857Medicaid
NC8101857Medicaid