Evan Mark Paradis, BS ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT459 Issued in ME

Practice address

100 Middle St Apt 1
Old Town, ME 04468-1480

Phone

(207) 659-9621

NPI assigned

Jun 11, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1560211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560211200000",
    "number": "1144889403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MIDDLE ST APT 1",
            "city": "OLD TOWN",
            "state": "ME",
            "postal_code": "044681480",
            "telephone_number": "207-659-9621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MIDDLE ST APT 1",
            "city": "OLD TOWN",
            "state": "ME",
            "postal_code": "044681480",
            "telephone_number": "207-659-9621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARADIS",
        "first_name": "EVAN",
        "middle_name": "MARK",
        "credential": "BS ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-11",
        "last_updated": "2019-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "ME",
            "license": "AT459",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Bangor",
            "affiliation": "N",
            "address_1": "100 Middle St Apt 1",
            "city": "Old Town",
            "state": "ME",
            "country_code": "US",
            "postal_code": "044681480",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Emily Odermann
• Heather D Okeefe, PMHNP
• Old Town Residential Services Corp.
• Old Town School Dept.
• Jenny Marie Omlor, LCPC-C, CADC
• Kaliope C. Parousis, DO
• Sharon Ann Peacock, MED
• Penobscot Community Health Center
• Penobscot Community Health Center
• Penobscot Community Health Center

• Athletic Trainer in Old Town, ME
• Providers in Old Town, ME by specialty
• Athletic Trainer in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.