Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 011788 | ME |
N | 207QA0401X | Family Doctor - Addiction Medicine | 011788 | ME |
NPI | 1427023324 |
---|---|
Provider Name | Dorothy Marie Thayer |
First Address | Livermore Falls, ME 04254-1229 |
Second Address | Livermore Falls, ME 04254-1229 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 17/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
046910 | ANTHEM (01) | ME |
3410872 | AETNA (01) | ME |
404570000 | (05) | ME |
C66445 | (02) |