Provider Demographics
NPI:1255416772
Name:LANDRIGAN, CHRYS J (PA-C, MPAS)
Entity type:Individual
Prefix:MS
First Name:CHRYS
Middle Name:J
Last Name:LANDRIGAN
Suffix:
Gender:F
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1048 UNION ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401
Mailing Address - Country:US
Mailing Address - Phone:207-945-5247
Mailing Address - Fax:207-992-2154
Practice Address - Street 1:86 DAVIS RD
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-2311
Practice Address - Country:US
Practice Address - Phone:207-992-2205
Practice Address - Fax:207-992-2207
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA782363A00000X
MEPA164363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME303160099Medicaid
MM9086OtherMEDICARE GROUP #
P02373Medicare UPIN