1043264468 NPI number — MRS. MARCIA MERCEILLE GILBERT MS, CCC/A

Table of content: MRS. MARCIA MERCEILLE GILBERT MS, CCC/A (NPI 1043264468)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043264468 NPI number — MRS. MARCIA MERCEILLE GILBERT MS, CCC/A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILBERT
Provider First Name:
MARCIA
Provider Middle Name:
MERCEILLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, CCC/A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAMMETT
Provider Other First Name:
MARCIA
Provider Other Middle Name:
MERCEILLE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1043264468
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
312 WING RD
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
HERMON
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04401-0424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-848-7007
Provider Business Mailing Address Fax Number:
207-848-7007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
312 WING RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
HERMON
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04401-0424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-848-7007
Provider Business Practice Location Address Fax Number:
207-848-7007
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  AP 1091 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 231HA2400X , with the licence number: AP1091 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 231HA2500X , with the licence number: AP1091 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 237600000X , with the licence number: DL20000375 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 237700000X , with the licence number: DL20000375 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 061498 . This is a "ANTHEM" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 3909913 . This is a "AETNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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