Provider Demographics
NPI:1669723730
Name:MANIATES, CHARITY (MSPH, MPH, PAC)
Entity type:Individual
Prefix:
First Name:CHARITY
Middle Name:
Last Name:MANIATES
Suffix:
Gender:F
Credentials:MSPH, MPH, PAC
Other - Prefix:
Other - First Name:CHARITY
Other - Middle Name:
Other - Last Name:LOWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPA, MPH, PAC
Mailing Address - Street 1:66 BRAMHALL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3344
Mailing Address - Country:US
Mailing Address - Phone:207-662-3157
Mailing Address - Fax:
Practice Address - Street 1:66 BRAMHALL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3344
Practice Address - Country:US
Practice Address - Phone:207-662-3157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA1360363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0030146Medicare PIN
ME003014601Medicare PIN