1154944312 NPI number — MOLLIE RUTH MYERS MD

Table of content: MOLLIE RUTH MYERS MD (NPI 1154944312)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154944312 NPI number — MOLLIE RUTH MYERS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MYERS
Provider First Name:
MOLLIE
Provider Middle Name:
RUTH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1154944312
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
43 WHITING HILL RD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BREWER
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04412-1006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-973-5035
Provider Business Mailing Address Fax Number:
207-973-5042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
895 UNION ST STE 12
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BANGOR
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04401-3054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-973-7979
Provider Business Practice Location Address Fax Number:
207-947-9579
Provider Enumeration Date:
05/22/2020

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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