Active NPI
Kathryn W Roseberry, P.A.
- Physician Assistant
- Bangor, ME
National Provider Identifier
1851309223
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA-286
- Practice address
- 489 State St
Emergency Department
Bangor, ME 04401-6616 - Phone
- (207) 973-7250
- Fax
- (207) 973-5656
- NPI assigned
- Aug 3, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA-286 | ME | Primary |
Addresses
Primary practice location
489 State St
Emergency Department
Bangor, ME 04401-6616
Mailing address
489 State St
Emergency Department
Bangor, ME 04401-6616
Phone (207) 973-7250
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA-286 | ME | MD | Physician Assistant |
| PA286 | ME | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154563200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1851309223",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "489 STATE ST",
"address_2": "EMERGENCY DEPARTMENT",
"city": "BANGOR",
"state": "ME",
"postal_code": "044016616",
"telephone_number": "207-973-7250",
"fax_number": "207-973-5656"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "489 STATE ST",
"address_2": "EMERGENCY DEPARTMENT",
"city": "BANGOR",
"state": "ME",
"postal_code": "044016616",
"telephone_number": "207-973-7250",
"fax_number": "207-973-5656"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSEBERRY",
"first_name": "KATHRYN",
"middle_name": "W",
"name_prefix": "Ms.",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "ME",
"license": "PA-286",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bangor, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.