Individual
THEODORE J PETTENGILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
226 MAIN STREET, SHERMAN, ME 04776-0000
(207) 365-4335
(207) 365-4336
Mailing address
226 MAIN STREET, SHERMAN, ME 04776-0000
(207) 365-4335
(207) 365-4336
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA048
ME
363A00000X
Physician Assistant
Primary
PA48
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
250940099
—
ME
Enumeration date
03/10/2006
Last updated
05/21/2013
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