Provider Demographics
NPI:1265550990
Name:UMBRIACO, SAMUEL E (PA-C)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:E
Last Name:UMBRIACO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 16022
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04243
Mailing Address - Country:US
Mailing Address - Phone:207-563-4250
Mailing Address - Fax:207-563-4561
Practice Address - Street 1:96 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074
Practice Address - Country:US
Practice Address - Phone:207-563-4250
Practice Address - Fax:207-563-4561
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA 0015058363A00000X
MEPA1058363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0000289Medicare PIN