Provider Demographics
NPI:1346287596
Name:TEN, RITA FOUAD (MD)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:FOUAD
Last Name:TEN
Suffix:
Gender:F
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:PO BOX 317
Mailing Address - Street 2:
Mailing Address - City:MACHIAS
Mailing Address - State:ME
Mailing Address - Zip Code:04654-0317
Mailing Address - Country:US
Mailing Address - Phone:207-255-6831
Mailing Address - Fax:207-255-6832
Practice Address - Street 1:229 MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MACHIAS
Practice Address - State:ME
Practice Address - Zip Code:04654
Practice Address - Country:US
Practice Address - Phone:207-255-6831
Practice Address - Fax:207-255-6832
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016317207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME255880000OtherMEDICAID BASE BILLING
ME035297OtherANTHEM OF MAINE
ME061135OtherANTHEM
MEP00196955OtherRAILROAD MEDICARE
ME255880099Medicaid
MEH97319Medicare UPIN
MEP00196955OtherRAILROAD MEDICARE