Healthcare Provider Details

I. General information

NPI: 1629266077
Provider Name (Legal Business Name): ALEJANDRO MEJIA P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
BIDDEFORD ME
04005-9422
US

IV. Provider business mailing address

PO BOX 626
BIDDEFORD ME
04005-0626
US

V. Phone/Fax

Practice location:
  • Phone: 207-283-7000
  • Fax:
Mailing address:
  • Phone: 207-283-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA223
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA223
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number001105
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: