Healthcare Provider Details

I. General information

NPI: 1104493345
Provider Name (Legal Business Name): ALYSSA NICOLE THOMAS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 OSSIPEE TRL E STE 1153
STANDISH ME
04084-6421
US

IV. Provider business mailing address

111 OSSIPEE TRL E STE 1153
STANDISH ME
04084-6421
US

V. Phone/Fax

Practice location:
  • Phone: 207-661-4850
  • Fax:
Mailing address:
  • Phone: 207-661-4850
  • Fax: 207-810-2416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO3862
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: