Healthcare Provider Details

I. General information

NPI: 1821877424
Provider Name (Legal Business Name): MAX MARTIN PISTNER PA-S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 STEVENS AVE
PORTLAND ME
04103-2656
US

IV. Provider business mailing address

35 MEDICAL CENTER PKWY
AUGUSTA ME
04330-8160
US

V. Phone/Fax

Practice location:
  • Phone: 207-248-7881
  • Fax:
Mailing address:
  • Phone: 207-252-5475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA2931
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: