Individual
MATTHEW J DEROSBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
234 STATE ST, BREWER, ME 04412-1519
(207) 989-0550
(207) 989-0551
Mailing address
43 WHITING HILL RD STE 300, BREWER, ME 04412-1006
(207) 989-0550
(207) 989-0551
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA534
ME
363AS0400X
Surgical Physician Assistant
PA534
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
205060099
—
ME
Enumeration date
04/25/2006
Last updated
11/15/2023
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