Provider Demographics
NPI:1184912677
Name:POOR, ROBERT J (PA-C)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:POOR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:301C US ROUTE ONE
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9701
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:119 GANNETT DR
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-6942
Practice Address - Country:US
Practice Address - Phone:207-774-2642
Practice Address - Fax:207-774-4293
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2014-11-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MEPA635363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30339347Medicaid
NH30339347Medicaid
MEAP103902Medicare PIN
MEP01112047Medicare PIN
MEAP103901Medicare PIN