Provider Demographics
NPI:1972611382
Name:CHAFFEE, ALAN D (PAC)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:D
Last Name:CHAFFEE
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MEDICAL CENTER LOOP
Mailing Address - Street 2:
Mailing Address - City:VINALHAVEN
Mailing Address - State:ME
Mailing Address - Zip Code:04863-4119
Mailing Address - Country:US
Mailing Address - Phone:207-863-4109
Mailing Address - Fax:207-863-9358
Practice Address - Street 1:15 MEDICAL CENTER LOOP
Practice Address - Street 2:
Practice Address - City:VINALHAVEN
Practice Address - State:ME
Practice Address - Zip Code:04863-4119
Practice Address - Country:US
Practice Address - Phone:207-863-4109
Practice Address - Fax:207-863-9358
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA549363A00000X
MEPA303363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P03082Medicare UPIN
AP1236Medicare ID - Type Unspecified