Provider Demographics
NPI:1689007064
Name:PELLETIER, DARREN R (MS, PA-C)
Entity type:Individual
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First Name:DARREN
Middle Name:R
Last Name:PELLETIER
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Gender:M
Credentials:MS, PA-C
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Mailing Address - Street 1:43 WHITING HILL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1006
Mailing Address - Country:US
Mailing Address - Phone:207-973-5035
Mailing Address - Fax:
Practice Address - Street 1:925 UNION ST
Practice Address - Street 2:SUITE 3
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3051
Practice Address - Country:US
Practice Address - Phone:207-973-9980
Practice Address - Fax:207-973-7515
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2020-05-28
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Provider Licenses
StateLicense IDTaxonomies
MEPA1413363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant