Basic Information
| Provider Information | |||||||||
| NPI: | 1740486034 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | DENISE | ||||||||
| MiddleName: | MARY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 GLEN COVE DR | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | ROCKPORT | ||||||||
| State: | ME | ||||||||
| PostalCode: | 048564235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2075935800 | ||||||||
| FaxNumber: | 2075935322 | ||||||||
| Practice Location | |||||||||
| Address1: | 4 GLEN COVE DR | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | ROCKPORT | ||||||||
| State: | ME | ||||||||
| PostalCode: | 048564235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2075935800 | ||||||||
| FaxNumber: | 2075935322 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2007 | ||||||||
| LastUpdateDate: | 02/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | DO2001 | ME | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 2001 | ME | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2001 | 01 | ME | OSTEOPATHIC LICENSURE | OTHER |