MEDICARE: TERRY ANN SCRIVEN MD

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
1	207Q00000X	Family Medicine Physician	013535	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MM486603	OTHER	ME	PTAN

General Provider Information

NPI Number	:	1629274543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRY ANN SCRIVEN MD

Provider Business Mailing Address
First Line	:	PO BOX 6233
Second Line	:	18 OLD OCEAN HOUSE ROAD
City	:	CAPE ELIZABETH
State	:	ME
Zip	:	04107-0033
Country	:	US
Telephone Number	:	207-699-0901
Fax Number	:	207-699-0902

Provider Business Practice Location Address
First Line	:	1226 SHORE RD
Second Line	:
City	:	CAPE ELIZABETH
State	:	ME
Zip	:	04107-2123
Country	:	US
Telephone Number	:	207-699-0901
Fax Number	:	207-699-0902

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2007
Last Update Date	:	04/30/2013

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Directions to “ TERRY ANN SCRIVEN MD” Practice Location

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