Healthcare Provider Details

I. General information

NPI: 1346167061
Provider Name (Legal Business Name): ABIGAIL ELIZABETH MASORTI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 UNION ST
BANGOR ME
04401-3051
US

IV. Provider business mailing address

144 EISENHOWER CROSS RD
MILL HALL PA
17751-9322
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-9980
  • Fax:
Mailing address:
  • Phone: 570-502-1621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3133
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: