Individual
NICOLAS ROBERT FENTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
331 VERANDA ST, PORTLAND, ME 04103-5545
(207) 828-2402
Mailing address
PO BOX 9746, PORTLAND, ME 04104-5040
(207) 791-3888
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2331
ME
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
12/28/2020
Last updated
03/26/2026
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