Provider Demographics
NPI:1538231725
Name:ALBRIGHT, BRENT A (PA)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:A
Last Name:ALBRIGHT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9422
Mailing Address - Country:US
Mailing Address - Phone:207-282-9080
Mailing Address - Fax:207-282-9180
Practice Address - Street 1:10 WELLSPRING RD
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9401
Practice Address - Country:US
Practice Address - Phone:207-283-1126
Practice Address - Fax:207-286-1359
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEPA801363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1538231725OtherANTHEM
ME7955852OtherAETNA
ME1538231725Medicaid
ME1538231725Medicaid