MEDICARE: SUSAN MARIE ST PIERRE DO

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	20A14943	CA
2	207Q00000X	Family Medicine Physician	1409	ME
3	2083A0300X	Addiction Medicine (Preventive Medicine) Physician	1409	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720076458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN MARIE ST PIERRE DO

Provider Business Mailing Address
First Line	:	4 SCAMMON ST STE 19-200
Second Line	:
City	:	SACO
State	:	ME
Zip	:	04072-5121
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1615 HILL RD STE 14
Second Line	:
City	:	NOVATO
State	:	CA
Zip	:	94947
Country	:	US
Telephone Number	:	415-895-1441
Fax Number	:	415-895-1288

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

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	05/23/2024

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Directions to “ SUSAN MARIE ST PIERRE DO” Practice Location

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