Provider Demographics
NPI:1801804281
Name:O'CONNOR, PAUL (PA)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:43 WHITING HILL ROAD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412
Mailing Address - Country:US
Mailing Address - Phone:207-973-7250
Mailing Address - Fax:207-973-5656
Practice Address - Street 1:489 STATE ST
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6616
Practice Address - Country:US
Practice Address - Phone:207-973-7250
Practice Address - Fax:207-973-5656
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2017-08-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MEPA-236363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1801804281Medicaid
MEOTH000Medicare UPIN
MEAP0489Medicare ID - Type Unspecified