Provider Demographics
NPI:1730153958
Name:PAINE, GORDON THOMAS JR (MD)
Entity type:Individual
Prefix:
First Name:GORDON
Middle Name:THOMAS
Last Name:PAINE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4 GLEN COVE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-4235
Mailing Address - Country:US
Mailing Address - Phone:207-593-5737
Mailing Address - Fax:207-593-5333
Practice Address - Street 1:4 GLEN COVE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-4235
Practice Address - Country:US
Practice Address - Phone:207-593-5737
Practice Address - Fax:207-593-5333
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2012-01-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ME8041208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E37148Medicare UPIN