Provider Demographics
NPI:1952391435
Name:PATTON, SARAH BLACK WIESENDANGER (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:BLACK WIESENDANGER
Last Name:PATTON
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 1:23 ROSEMARY LN
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-6034
Mailing Address - Country:US
Mailing Address - Phone:206-450-1361
Mailing Address - Fax:206-346-6022
Practice Address - Street 1:1601 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2102
Practice Address - Country:US
Practice Address - Phone:207-661-0100
Practice Address - Fax:207-661-0199
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10005002363AM0700X
MEPA2186363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1551PAOtherBLUE CROSS BLUE SHEILD
MDQ46481Medicare UPIN
WAG8859349Medicare PIN