Provider Demographics
NPI:1154384485
Name:GAUTHIER, MICHAEL N (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:N
Last Name:GAUTHIER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:127 LONG SANDS RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-1159
Mailing Address - Country:US
Mailing Address - Phone:207-363-8430
Mailing Address - Fax:207-351-3006
Practice Address - Street 1:127 LONG SANDS RD
Practice Address - Street 2:SUITE 11
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1159
Practice Address - Country:US
Practice Address - Phone:207-363-8430
Practice Address - Fax:207-351-3006
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2011-04-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MEME014829207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
010467585OtherMACHIGONNE
080140514OtherRAILROAD MEDICARE
271500099OtherPRIMECARE MEDICAID
ME271500099Medicaid
010467585OtherSTANDARD TAX ID
027332OtherANTHEM BCBS
6960100OtherCIGNA HEALTHCARE
NH0100365YPME01OtherANTHEM BCBS NEW HAMPSHIRE
010467585OtherAETNA HMO
010467585OtherAETNA NONHMO
F83718OtherHARVARD PILGRIM
6960100OtherCIGNA HEALTHCARE
F83718Medicare UPIN