Provider Demographics
NPI:1912077132
Name:PRABA-EGGE, ANITA D (MD)
Entity type:Individual
Prefix:DR
First Name:ANITA
Middle Name:D
Last Name:PRABA-EGGE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:12 HIGH ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7634
Mailing Address - Country:US
Mailing Address - Phone:207-795-5767
Mailing Address - Fax:207-795-2732
Practice Address - Street 1:12 HIGH ST
Practice Address - Street 2:SUITE 401
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7634
Practice Address - Country:US
Practice Address - Phone:207-795-5767
Practice Address - Fax:207-795-2732
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2012-11-06
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Provider Licenses
StateLicense IDTaxonomies
ME017641208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME000363401Medicare PIN
ME000363403Medicare PIN
ME000363402Medicare PIN