Provider Demographics
NPI:1083744429
Name:FORD, MARYBETH DUNSTON (MD)
Entity Type:Individual
Prefix:DR
First Name:MARYBETH
Middle Name:DUNSTON
Last Name:FORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8 MASON ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-1514
Mailing Address - Country:US
Mailing Address - Phone:207-729-7971
Mailing Address - Fax:207-725-7910
Practice Address - Street 1:8 MASON ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-1514
Practice Address - Country:US
Practice Address - Phone:207-729-7971
Practice Address - Fax:207-725-7910
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME012563207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME294970099Medicaid
E400189552EMedicare PIN
ME294970099Medicaid
E12670Medicare UPIN