Provider Demographics
NPI:1255389987
Name:BABIARZ, ANNA N (PAC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:N
Last Name:BABIARZ
Suffix:
Gender:F
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:PO BOX 1599
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-1599
Mailing Address - Country:US
Mailing Address - Phone:207-404-8200
Mailing Address - Fax:207-947-0435
Practice Address - Street 1:376 MAIN ST
Practice Address - Street 2:
Practice Address - City:JACKMAN
Practice Address - State:ME
Practice Address - Zip Code:04945-5214
Practice Address - Country:US
Practice Address - Phone:207-668-7755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA807363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME201907Medicare PIN
MEMM9086Medicare PIN