Provider Demographics
NPI:1194801993
Name:RIVARD, GARY S (DO)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:S
Last Name:RIVARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:180 CHURCH HILL RD
Mailing Address - Street 2:STE 1
Mailing Address - City:LEEDS
Mailing Address - State:ME
Mailing Address - Zip Code:04263-3418
Mailing Address - Country:US
Mailing Address - Phone:207-524-3501
Mailing Address - Fax:207-524-2093
Practice Address - Street 1:7 MAIN ST
Practice Address - Street 2:
Practice Address - City:TURNER
Practice Address - State:ME
Practice Address - Zip Code:04282-4138
Practice Address - Country:US
Practice Address - Phone:207-524-3501
Practice Address - Fax:207-225-2692
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEDO2113207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME434323099Medicaid
ME434323099Medicaid
ME001212501Medicare PIN
ME001212502Medicare PIN
MEE400376876Medicare PIN