Healthcare Provider Details

I. General information

NPI: 1225104482
Provider Name (Legal Business Name): JOEL D. CHRETIEN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 SEWALL ST
PORTLAND ME
04102-2603
US

IV. Provider business mailing address

33 SEWALL ST
PORTLAND ME
04102-2638
US

V. Phone/Fax

Practice location:
  • Phone: 207-828-2100
  • Fax: 207-553-7166
Mailing address:
  • Phone: 207-828-2100
  • Fax: 207-553-7166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPT1259
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA1259
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: