Provider Demographics
NPI:1427023324
Name:THAYER, DOROTHY MARIE (MD)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:MARIE
Last Name:THAYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 UNION ST
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE FALLS
Mailing Address - State:ME
Mailing Address - Zip Code:04254-1229
Mailing Address - Country:US
Mailing Address - Phone:207-376-9009
Mailing Address - Fax:
Practice Address - Street 1:38 UNION ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE FALLS
Practice Address - State:ME
Practice Address - Zip Code:04254-1229
Practice Address - Country:US
Practice Address - Phone:207-376-9009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2019-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME011788207QA0401X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME046910OtherANTHEM
ME3410872OtherAETNA
ME404570000Medicaid
MEMM873703Medicare PIN
MEMM873701Medicare PIN
ME046910OtherANTHEM
ME203838Medicare ID - Type Unspecified
MEMM8737Medicare PIN