Provider Demographics
NPI:1811272990
Name:UPEGUI, JOHN (PA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:UPEGUI
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 HARTFORD ST STE 1
Mailing Address - Street 2:
Mailing Address - City:HOULTON
Mailing Address - State:ME
Mailing Address - Zip Code:04730-1844
Mailing Address - Country:US
Mailing Address - Phone:207-532-4068
Mailing Address - Fax:207-532-9426
Practice Address - Street 1:22 HARTFORD ST STE 1
Practice Address - Street 2:
Practice Address - City:HOULTON
Practice Address - State:ME
Practice Address - Zip Code:04730-1844
Practice Address - Country:US
Practice Address - Phone:207-532-4068
Practice Address - Fax:207-532-9426
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9106014363AM0700X
MEPA2315363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical