Provider Demographics
NPI:1649457730
Name:PAQUETTE, MAURICE GERARD (PA-C)
Entity type:Individual
Prefix:
First Name:MAURICE
Middle Name:GERARD
Last Name:PAQUETTE
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 1:289 COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:VT
Mailing Address - Zip Code:05089-9000
Mailing Address - Country:US
Mailing Address - Phone:802-674-7310
Mailing Address - Fax:802-674-7349
Practice Address - Street 1:289 COUNTY RD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:VT
Practice Address - Zip Code:05089-9000
Practice Address - Country:US
Practice Address - Phone:802-674-7310
Practice Address - Fax:802-674-7349
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0664363A00000X
MAAP 2506363A00000X
VT055-0031080363A00000X
VT055-0031081363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30336614Medicaid
NH0005525Medicare PIN