Provider Demographics
NPI:1073281473
Name:TAHAR, MAIDE T
Entity Type:Individual
Prefix:
First Name:MAIDE
Middle Name:T
Last Name:TAHAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PLUMMER ST APT 149
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-7005
Mailing Address - Country:US
Mailing Address - Phone:978-849-4078
Mailing Address - Fax:
Practice Address - Street 1:15 PLUMMER ST APT 149
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-7005
Practice Address - Country:US
Practice Address - Phone:978-849-4078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty