Healthcare Provider Details

I. General information

NPI: 1801570643
Provider Name (Legal Business Name): CHARLOTTE A BRASSEUX PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 BRAMHALL ST
PORTLAND ME
04102-3134
US

IV. Provider business mailing address

22 BRAMHALL ST
PORTLAND ME
04102-3134
US

V. Phone/Fax

Practice location:
  • Phone: 207-662-2179
  • Fax: 207-662-6326
Mailing address:
  • Phone: 207-662-2179
  • Fax: 207-662-6326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3073
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00798000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: