1225013659 NPI number — MR. ALFRED BERNARD CICHON PHYSICIAN ASSISTANT

Table of content: MR. ALFRED BERNARD CICHON PHYSICIAN ASSISTANT (NPI 1225013659)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225013659 NPI number — MR. ALFRED BERNARD CICHON PHYSICIAN ASSISTANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CICHON
Provider First Name:
ALFRED
Provider Middle Name:
BERNARD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PHYSICIAN ASSISTANT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225013659
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ONE WESTON CT
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04330-5543
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-623-5142
Provider Business Mailing Address Fax Number:
207-623-5138

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 WESTON CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04330-5543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-623-5142
Provider Business Practice Location Address Fax Number:
207-623-5142
Provider Enumeration Date:
12/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  248 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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