Healthcare Provider Details

I. General information

NPI: 1508952813
Provider Name (Legal Business Name): REID KINCAID PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ASHLEY REID KINCAID PA-C

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 03/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 ARSENAL ST
AUGUSTA ME
04330-5742
US

IV. Provider business mailing address

581 S STRONG RD
FARMINGTON ME
04938-5108
US

V. Phone/Fax

Practice location:
  • Phone: 207-779-7484
  • Fax: 207-287-6123
Mailing address:
  • Phone: 207-778-9901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA769
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: