Healthcare Provider Details

I. General information

NPI: 1811077696
Provider Name (Legal Business Name): KAREN ANNE MARLIN PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DUDLEY COE HEALTH CENTER BOWDOIN COLLEGE 3600 COLLEGE STATION
BRUNSWICK ME
04011
US

IV. Provider business mailing address

10 SEA GRASS FARM RD
BRUNSWICK ME
04011-7841
US

V. Phone/Fax

Practice location:
  • Phone: 207-725-3770
  • Fax:
Mailing address:
  • Phone: 207-798-5028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA079
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: