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General NPI Number Information
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NPI Number | 1427219948
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Entity Type | Individual
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Provider Name | THOR AGUSTSSON DO
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Gender | Male
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Dates
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Enumeration Date | 06/18/2008
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Last Update Date | 12/21/2015
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Provider Practice Location Address
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Address Line | 1 MAIN ST
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City | NASHUA
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State | NH
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Zip | 03064-2716
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Country | US
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Telephone | 603-883-0005
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Fax | 603-883-0007
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Provider Business Mailing Address
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Address Line | 78 ATLANTIC PL
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-2316
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Country | US
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Telephone | 207-661-6654
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Fax | 207-842-7773
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036.130493
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | OS 12078
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | DO2450
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License Number State | ME
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 17292
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License Number State | NH
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