Individual
MARK A DEBIASIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
119 GANNETT DR, SOUTH PORTLAND, ME 04106-6942
(207) 773-0040
(207) 774-6501
Mailing address
190 RIVERSIDE ST, SUITE 6B, PORTLAND, ME 04103-1073
(207) 661-2000
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA1239
ME
Other
Enumeration date
07/21/2008
Last updated
04/15/2024
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