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Individual

ANGELA DIANE BACCHIOCCHI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
417 STATE ST, SUITE 221, BANGOR, ME 04401-6630
(207) 973-9949
Mailing address
909 BLACKSTREAM RD, HERMON, ME 04401-0207
(413) 575-6118

Taxonomy

Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA1350
ME

Other

Enumeration date
07/30/2012
Last updated
07/30/2012
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