Provider Demographics
NPI:1306026794
Name:TRITCH, TODD ALAN (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:ALAN
Last Name:TRITCH
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 1:30 COBBS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NEW GLOUCESTER
Mailing Address - State:ME
Mailing Address - Zip Code:04260-3838
Mailing Address - Country:US
Mailing Address - Phone:207-756-3571
Mailing Address - Fax:
Practice Address - Street 1:30 COBBS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:NEW GLOUCESTER
Practice Address - State:ME
Practice Address - Zip Code:04260-3838
Practice Address - Country:US
Practice Address - Phone:207-756-3571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013713207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine