Provider Demographics
NPI:1083100341
Name:BEHMER, MARIAN ALEXA (PA-C)
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:ALEXA
Last Name:BEHMER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARIAN
Other - Middle Name:ALEXA
Other - Last Name:CORCORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 GANNETT DR STE C
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-5900
Mailing Address - Country:US
Mailing Address - Phone:207-828-0361
Mailing Address - Fax:207-874-1483
Practice Address - Street 1:50 FODEN RD STE 3
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-1718
Practice Address - Country:US
Practice Address - Phone:207-523-3700
Practice Address - Fax:207-523-8590
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA2009363A00000X
WI7532363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1083100341Medicaid