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NPI Code Detail

MEDICARE: MS. DALY ANNE JOHNSON PA-C

MEDICARE: MS. DALY ANNE JOHNSON PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA2364ME
2363AS0400XSurgical Physician AssistantPA2364ME

General Provider Information

NPI Number : 1104553247
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DALY ANNE JOHNSON PA-C
Provider Business Mailing Address
First Line : 22 BRAMHALL ST
Second Line :
City : PORTLAND
State : ME
Zip : 04102-3134
Country : US
Telephone Number : 207-662-2934
Fax Number : 207-662-6389
Provider Business Practice Location Address
First Line : 22 BRAMHALL ST
Second Line :
City : PORTLAND
State : ME
Zip : 04102-3175
Country : US
Telephone Number : 207-662-0111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2022
Last Update Date : 01/05/2026

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