Provider Demographics
NPI:1124096557
Name:STANNARD, VICTORIA ANN (MD)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:ANN
Last Name:STANNARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:VICTORIA
Other - Middle Name:ANN
Other - Last Name:WOROSZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 468
Mailing Address - Street 2:
Mailing Address - City:SKOWHEGAN
Mailing Address - State:ME
Mailing Address - Zip Code:04976-0468
Mailing Address - Country:US
Mailing Address - Phone:207-474-7045
Mailing Address - Fax:207-474-5173
Practice Address - Street 1:PO BOX 468
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-0468
Practice Address - Country:US
Practice Address - Phone:207-474-7045
Practice Address - Fax:207-474-5173
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11884208600000X
MEMD16980208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1124096557Medicaid