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General NPI Number Information
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NPI Number | 1790070654
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Entity Type | Individual
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Provider Name | MATTHEW PICARD
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Gender | Male
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Dates
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Enumeration Date | 06/17/2011
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Last Update Date | 08/12/2014
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Provider Practice Location Address
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Address Line | 15 HOSPITAL DR
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City | BRIDGTON
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State | ME
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Zip | 04009-1156
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Country | US
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Telephone | 207-647-3421
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Fax |
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Provider Business Mailing Address
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Address Line | 15 HOSPITAL DR
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City | BRIDGTON
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State | ME
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Zip | 04009-1156
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Country | US
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Telephone | 207-647-3421
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA001280
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License Number State | ME
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