Individual
ELIZABETH A. PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
84 MARGINAL WAY, SUITE 800, PORTLAND, ME 04101
(207) 774-5816
(207) 523-8595
Mailing address
100 GANNETT DRIVE, SUITE C, SOUTH PORTLAND, ME 04106
(207) 828-0361
(207) 874-1483
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA 749
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30336245
—
NH
05
—
431962899
—
ME
Enumeration date
01/09/2007
Last updated
03/27/2014
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