Provider Demographics
NPI:1326085333
Name:DAUPHIN, KATHY (MT)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:DAUPHIN
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 NICHOLS ST
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:ME
Mailing Address - Zip Code:04530-1846
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 NICHOLS ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530-1846
Practice Address - Country:US
Practice Address - Phone:207-443-8013
Practice Address - Fax:207-443-8013
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT55174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME048935OtherANTHEM BLUE CROSS BLUE SH