Provider Demographics
NPI:1639364243
Name:PATSIORNIK, YELENA (MD)
Entity type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:PATSIORNIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 WHITING HILL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1006
Mailing Address - Country:US
Mailing Address - Phone:207-973-5000
Mailing Address - Fax:207-973-5042
Practice Address - Street 1:43 WHITING HILL RD STE 300
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-1006
Practice Address - Country:US
Practice Address - Phone:207-973-7478
Practice Address - Fax:207-973-7807
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD18105207RH0003X
AZ50610207RH0003X
ME018105207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ033286OtherAHCCCS
AZZ181249Medicare PIN
AZZ180893Medicare PIN