Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PS569 | ME |
Y | 103T00000X | Psychologist | PS569 | ME |
NPI | 1013086602 |
---|---|
Provider Name | Dr. Thomas P Cushman |
First Address | Auburn, ME 04210-5019 |
Second Address | Auburn, ME 04210-5019 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03308 | ANTHEM BLUE SHIELD (01) | ME |