=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104493345
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALYSSA NICOLE THOMAS DO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2021
-----------------------------------------------------
Last Update Date | 05/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 OSSIPEE TRL E STE 1153
-----------------------------------------------------
City | STANDISH
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04084-6421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-661-4850
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 OSSIPEE TRL E STE 1153
-----------------------------------------------------
City | STANDISH
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04084-6421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-661-4850
-----------------------------------------------------
Fax | 207-810-2416
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | DO3862
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------