Provider Demographics
NPI:1629358122
Name:DOBOS, KATHRYN (NP-C)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:DOBOS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:MCNAMARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301C US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9701
Mailing Address - Country:US
Mailing Address - Phone:207-396-9600
Mailing Address - Fax:
Practice Address - Street 1:5 BUCKNAM RD
Practice Address - Street 2:SUITE1D
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1392
Practice Address - Country:US
Practice Address - Phone:207-781-1552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-28
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2267825363LF0000X
MECNP151109363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1629358122Medicaid
MEE400296243Medicare PIN