Healthcare Provider Details

I. General information

NPI: 1275724114
Provider Name (Legal Business Name): CARLEY E MEJIA P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARLEY E BARTOLOME PA

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 SHAPE DR
KENNEBUNK ME
04043-6601
US

IV. Provider business mailing address

9 HEALTHCARE DR SUITE 201
BIDDEFORD ME
04005-9449
US

V. Phone/Fax

Practice location:
  • Phone: 207-467-8930
  • Fax: 207-467-8969
Mailing address:
  • Phone: 207-282-9080
  • Fax: 207-282-9180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA001103
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier432995099
Identifier TypeMEDICAID
Identifier StateME
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: