Provider Demographics
NPI:1831166693
Name:BOSINSKE, AMY B (PA C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:B
Last Name:BOSINSKE
Suffix:
Gender:F
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 1:81 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 2350
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2764
Mailing Address - Country:US
Mailing Address - Phone:207-373-6690
Mailing Address - Fax:207-373-6695
Practice Address - Street 1:81 MEDICAL CENTER DRIVE
Practice Address - Street 2:SUITE 2350
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011
Practice Address - Country:US
Practice Address - Phone:207-373-6690
Practice Address - Fax:207-373-6695
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA745363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
010424957OtherTRICARE
P0061OtherBCBS GROUP
P88047OtherBCBS
010424957OtherEMPLOY STANDARDS
010424957OtherCHAMPUS
250012128OtherMEDICARE RAILROAD GROUP
010424957OtherAETNA GROUP
010424957OtherHARVARD PILGRIM GROUP
010424957OtherSTANDARD TAX ID
010424957OtherHARVARD PILGRIM GROUP
P88047OtherBCBS