MEDICARE: KRYSTEL ELLIOTT-THEBERGE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD24893	ME

General Provider Information

NPI Number	:	1518537463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTEL ELLIOTT-THEBERGE MD

Provider Business Mailing Address
First Line	:	603 MAIN RD N
Second Line	:
City	:	HAMPDEN
State	:	ME
Zip	:	04444-1804
Country	:	US
Telephone Number	:	207-945-5400
Fax Number	:	207-945-8300

Provider Business Practice Location Address
First Line	:	603 MAIN RD N
Second Line	:
City	:	HAMPDEN
State	:	ME
Zip	:	04444-1804
Country	:	US
Telephone Number	:	207-945-5400
Fax Number	:	207-945-8300

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2021
Last Update Date	:	01/10/2025

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