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NPI Code Detail

MEDICARE: TORI N THORESON PA

MEDICARE: TORI N THORESON PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantPA1309ME

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PA1309OTHERMELICENSE

General Provider Information

NPI Number : 1063719375
Entity Type Code : Individual
Provider Name (Legal Business Name) : TORI N THORESON PA
Provider Business Mailing Address
First Line : PO BOX 500
Second Line :
City : PATTEN
State : ME
Zip : 04765-0500
Country : US
Telephone Number : 207-528-2285
Fax Number : 207-528-2595
Provider Business Practice Location Address
First Line : 30 HOULTON ST
Second Line :
City : PATTEN
State : ME
Zip : 04765-3035
Country : US
Telephone Number : 207-528-2285
Fax Number : 207-528-2595
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2011
Last Update Date : 04/04/2016

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Directions to “ TORI N THORESON PA” Practice Location

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