Provider Demographics
NPI:1528096468
Name:GILL, RUPINDER S (PA-C)
Entity type:Individual
Prefix:
First Name:RUPINDER
Middle Name:S
Last Name:GILL
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 1:301C US ROUTE 1
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 1:5 BUCKNAM RD
Practice Address - Street 2:SUITE 1D
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1392
Practice Address - Country:US
Practice Address - Phone:207-781-1551
Practice Address - Fax:207-781-1552
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA-808363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME30332347OtherNH MEDICAID
MEM3850OtherCIGNA
ME1120990001OtherDMERC
ME292060099Medicaid
ME046412OtherANTHEM
MEAP1968Medicare PIN
ME046412OtherANTHEM
MEM3850OtherCIGNA
MEP93315Medicare UPIN