Provider Demographics
NPI:1164498630
Name:PAKIAM, ANTHONY S (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:S
Last Name:PAKIAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 WINTHROP ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5501
Mailing Address - Country:US
Mailing Address - Phone:207-626-0481
Mailing Address - Fax:207-622-6078
Practice Address - Street 1:56 WINTHROP ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5501
Practice Address - Country:US
Practice Address - Phone:207-626-0481
Practice Address - Fax:207-622-6078
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0152472084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME133200099Medicaid
ME133200099Medicaid
MEG70461Medicare UPIN
MEMM8032Medicare PIN