Provider Demographics
NPI:1518745652
Name:MUTCHIE, MICHAEL C (PA-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:MUTCHIE
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 1:193 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORWAY
Mailing Address - State:ME
Mailing Address - Zip Code:04268-5645
Mailing Address - Country:US
Mailing Address - Phone:207-828-2100
Mailing Address - Fax:
Practice Address - Street 1:193 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04268-5645
Practice Address - Country:US
Practice Address - Phone:207-828-2100
Practice Address - Fax:207-743-5026
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
MEPA2780363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant