1861538746 NPI number — SHANNON P DOWDLE MS CCCA

Table of content: SHANNON P DOWDLE MS CCCA (NPI 1861538746)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861538746 NPI number — SHANNON P DOWDLE MS CCCA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOWDLE
Provider First Name:
SHANNON
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS CCCA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PHINNEY
Provider Other First Name:
SHANNON
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1861538746
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
347 MAIN ST
Provider Second Line Business Mailing Address:
SUITE 1A
Provider Business Mailing Address City Name:
GORHAM
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04038-1338
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-839-8400
Provider Business Mailing Address Fax Number:
866-596-0877

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
347 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 1A
Provider Business Practice Location Address City Name:
GORHAM
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04038-1338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-839-8400
Provider Business Practice Location Address Fax Number:
866-596-0877
Provider Enumeration Date:
01/29/2007

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:  AP1233 , 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: 098737 . This is a "ANTHEM BCBS" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 264240099 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com