Provider Demographics
NPI:1194736793
Name:ALBERT, MARIE (DO)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:ALBERT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1599
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-1599
Mailing Address - Country:US
Mailing Address - Phone:207-945-5247
Mailing Address - Fax:207-947-0435
Practice Address - Street 1:735 WILSON ST
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-1000
Practice Address - Country:US
Practice Address - Phone:207-285-3312
Practice Address - Fax:207-285-7320
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1221207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME259640099Medicaid
ME010474554OtherMEDNET
ME017711OtherANTHEM BC BS
MEB86288OtherHARVARD PILGRIM
AL1044320OtherAETNA
MEM3260OtherCIGNA
MEMM2660Medicare ID - Type Unspecified
AL1044320OtherAETNA