Individual
MEREDITH BEAUREGARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
22 BRAMHALL ST, PAVILION 1203, PORTLAND, ME 04102
(207) 662-4618
(207) 662-6254
Mailing address
301 US ROUTE 1, BUILDING C, SCARBOROUGH, ME 04074-7609
(207) 396-8600
(207) 396-8632
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA883
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
432498699
—
ME
Enumeration date
05/11/2006
Last updated
01/03/2011
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