1508925629 NPI number — MS. AMY ENGLER BOOTH MA CCCA FAAA

Table of content: MS. AMY ENGLER BOOTH MA CCCA FAAA (NPI 1508925629)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508925629 NPI number — MS. AMY ENGLER BOOTH MA CCCA FAAA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOOTH
Provider First Name:
AMY
Provider Middle Name:
ENGLER
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA CCCA FAAA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508925629
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:
5724 DUNN HALL
Provider Second Line Business Mailing Address:
ROOM 336 UNIVERSITY OF MAINE
Provider Business Mailing Address City Name:
ORONO
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04469-5724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-581-2011
Provider Business Mailing Address Fax Number:
207-581-2060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5724 DUNN HALL
Provider Second Line Business Practice Location Address:
ROOM 336 UNIVERSITY OF MAINE
Provider Business Practice Location Address City Name:
ORONO
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04469-5724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-581-2011
Provider Business Practice Location Address Fax Number:
207-581-2060
Provider Enumeration Date:
12/06/2006

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:  AP940 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 028000 . This is a "ANTHEM BCBS" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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