Healthcare Provider Details

I. General information

NPI: 1841262417
Provider Name (Legal Business Name): THOMAS G BARTOL NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 05/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 GARDINER ST
RICHMOND ME
04357
US

IV. Provider business mailing address

24 GARDINER ST
RICHMOND ME
04357
US

V. Phone/Fax

Practice location:
  • Phone: 207-737-4359
  • Fax: 207-737-4412
Mailing address:
  • Phone: 207-737-4359
  • Fax: 207-737-4412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number42208
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: