Provider Demographics
NPI:1366486482
Name:CARSON, PATRICK S (PA-C)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:S
Last Name:CARSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 FORE RIVER PKWY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2779
Mailing Address - Country:US
Mailing Address - Phone:207-879-3265
Mailing Address - Fax:
Practice Address - Street 1:175 FORE RIVER PKWY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2779
Practice Address - Country:US
Practice Address - Phone:207-879-3265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA-477363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME050167OtherANTHEM PIN
ME050167OtherANTHEM PIN
MES74670Medicare UPIN