Look up the most recent NPI and PECOS records

Daniel Large

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

PECOS Enrollment

Based on the most recent information from CMS, provider Daniel Large is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 2:35 PM.

Profile Details

Provider ID
1508305707
Provider Type
Individual
Full Name
Large, Daniel
Credential
PA-C

Gender
Male
Sole Proprietor
No
Enumeration Date
2/21/2017
Last Updated
4/23/2020

Contact Information

Practice Location

22 Bramhall St, Portland, ME 04102-3134

(207) 885-0011

Unlisted Fax

Mailing Location

49 Spring St, Mmp Neurosurgery And Spine, Scarborough, ME 04074

(207) 885-0011

(207) 885-5851

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License PA2028 Maine
Code 363A00000X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License PA6046 Massachusetts
Code 363AS0400X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License PA2028 Maine

Daniel Large

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

Halterman, Jon M

Beauregard, Meredith

Foley, Sheila Marie

Lebourdais, Laura Ann

Prescott, William Charles

Ballard, Kathleen Marie

Joldersma, Logan

Butterfield, Blue B

Mckenna, Sarah Faye

Hazen, Gordon Loughlin