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1265422943

NPI Code Detail

MEDICARE: KRISTINA CHADWICK PA-C

MEDICARE: KRISTINA CHADWICK PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA631	ME

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	201017	OTHER		MEDICARE ASC FACILITY
4	MM0716	OTHER		MEDICARE CLINIC FACILITY
10	970026374	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	010416156	OTHER		CIGNA / GREAT WEST
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	010416156	OTHER		CORE / MEDNET / TRAVELERS
6	0378600001	OTHER		DMERC
7	AP1070	OTHER		PTAN
8	025716	OTHER		ANTHEM
9	100294000	OTHER		USPS WC
11	1044480	OTHER		AETNA

General Provider Information

NPI Number	:	1265422943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA CHADWICK PA-C

Provider Business Mailing Address
First Line	:	300 MAIN ST
Second Line	:
City	:	LEWISTON
State	:	ME
Zip	:	04240-7027
Country	:	US
Telephone Number	:	207-795-0111
Fax Number	:	207-795-7133

Provider Business Practice Location Address
First Line	:	300 MAIN ST
Second Line	:
City	:	LEWISTON
State	:	ME
Zip	:	04240-7027
Country	:	US
Telephone Number	:	207-795-0111
Fax Number	:	207-795-7133

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	09/11/2009

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Directions to “ KRISTINA CHADWICK PA-C” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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