Provider Demographics
NPI:1982641833
Name:LEVESQUE, ELIZABETH S (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:S
Last Name:LEVESQUE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:ALICE-MAY
Other - Last Name:SONDHEIM LEVESQUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:144 STATE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3776
Mailing Address - Country:US
Mailing Address - Phone:207-879-3049
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:04101-3776
Practice Address - Country:US
Practice Address - Phone:207-879-3049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA-678363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30338040Medicaid
MEP00395094OtherRAILROAD MEDICARE
ME433851099Medicaid
MEQ21749Medicare UPIN
MEAP2211Medicare PIN
ME433851099Medicaid
MEP00395094OtherRAILROAD MEDICARE