Individual
BETHANY JEAN GATES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA C
Contact information
Practice address
6 E CHESTNUT ST STE C-3, AUGUSTA, ME 04330-5717
(207) 626-1594
Mailing address
6 E CHESTNUT ST STE C-3, AUGUSTA, ME 04330-5717
(804) 285-4465
(804) 285-8332
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0110001499
VA
363AM0700X
Medical Physician Assistant
Primary
PA1330
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010005175
—
VA
Enumeration date
09/27/2005
Last updated
03/01/2013
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