Healthcare Provider Details

I. General information

NPI: 1578059200
Provider Name (Legal Business Name): MEAGHAN NORA MATTERA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MEDICAL CENTER PKWY STE 101
AUGUSTA ME
04330-8160
US

IV. Provider business mailing address

35 MEDICAL CENTER PKWY STE 101
AUGUSTA ME
04330-8160
US

V. Phone/Fax

Practice location:
  • Phone: 207-430-4321
  • Fax:
Mailing address:
  • Phone: 207-430-4321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number025263
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number055.0031692
License Number StateVT
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2688
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: