Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 1508 | ME |
Y | 207Q00000X | Family Doctor | 1508 | ME |
NPI | 1386751972 |
---|---|
Provider Name | Dr. Mary Ashmore |
First Address | Camden, ME 04843-1614 |
Second Address | Camden, ME 04843-1614 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 04/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
130430000 | (05) | ME |
G31621 | (02) | ME |