Provider Demographics
NPI:1548494552
Name:DMYTRASZ, KAREN E (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:E
Last Name:DMYTRASZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 626
Mailing Address - Street 2:ONE MEDICAL CENTER DRIVE
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005
Mailing Address - Country:US
Mailing Address - Phone:207-283-8800
Mailing Address - Fax:207-286-9853
Practice Address - Street 1:13 INDUSTRIAL PARK ROAD
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072
Practice Address - Country:US
Practice Address - Phone:207-283-8800
Practice Address - Fax:207-286-9853
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD19803207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1548494552Medicaid
ME1548494552OtherANTHEM
MEAA31749OtherHARVARD PILGRIM
ME4715521OtherAETNA
ME3160105OtherCIGNA
ME003406701Medicare PIN