1154385995 NPI number — DR. MICHAEL R MARCOTTE D.C.

Table of content: DR. MICHAEL R MARCOTTE D.C. (NPI 1154385995)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154385995 NPI number — DR. MICHAEL R MARCOTTE D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARCOTTE
Provider First Name:
MICHAEL
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

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:
1154385995
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 SHAKER ROAD
Provider Second Line Business Mailing Address:
PO BOX 215
Provider Business Mailing Address City Name:
GRAY
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04039-9531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-657-7101
Provider Business Mailing Address Fax Number:
207-657-7165

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 SHAKER ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAY
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04039-9531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-657-7101
Provider Business Practice Location Address Fax Number:
207-657-7165
Provider Enumeration Date:
04/17/2006

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: 111N00000X , with the licence number:  CR1361 , 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: 175150099 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3692954 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 69304 . This is a "CIGNA PROVIDER NUMBER" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 352502 . This is a "HARVARD PILGRIM PROVIDER" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 061123 . This is a "BC/BS PROVIDER ID" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com