=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467432583
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEIRDRE A. GRAMAS M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2006
-----------------------------------------------------
Last Update Date | 06/27/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 817 COMMERCIAL ST
-----------------------------------------------------
City | ROCKPORT
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04856-4243
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-594-4308
-----------------------------------------------------
Fax | 207-594-3326
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 817 COMMERCIAL ST
-----------------------------------------------------
City | ROCKPORT
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04856-4243
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-594-4308
-----------------------------------------------------
Fax | 207-594-3326
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number | 013712
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------