1144507948 NPI number — DR. ANDREW PERCY IVERSON,MD II MD

Table of content: DR. ANDREW PERCY IVERSON,MD II MD (NPI 1144507948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144507948 NPI number — DR. ANDREW PERCY IVERSON,MD II MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IVERSON,MD
Provider First Name:
ANDREW
Provider Middle Name:
PERCY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
II
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
IVERSON, MD
Provider Other First Name:
ANDREW
Provider Other Middle Name:
PERCY
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
II
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1144507948
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 STAPLES POINT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREEPORT
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04032-6003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-865-3905
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 STAPLES POINT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREEPORT
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04032-6003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-865-3905
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/08/2011

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: 208800000X , with the licence number:  6119 , 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)





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