Healthcare Provider Details

I. General information

NPI: 1760038152
Provider Name (Legal Business Name): CHRISTINA MACAULAY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 08/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 MAIN ST
NORWAY ME
04268-5664
US

IV. Provider business mailing address

653 RUSTIC DR
KILLINGTON VT
05751-9477
US

V. Phone/Fax

Practice location:
  • Phone: 207-743-5933
  • Fax:
Mailing address:
  • Phone: 802-236-4485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA1961
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: