Provider Demographics
NPI:1356305411
Name:DOWD, MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:DOWD
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 724
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04332-0724
Mailing Address - Country:US
Mailing Address - Phone:207-822-0232
Mailing Address - Fax:207-822-0237
Practice Address - Street 1:63 PREBLE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3014
Practice Address - Country:US
Practice Address - Phone:207-822-0232
Practice Address - Fax:207-822-0237
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013040207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM462301Medicare PIN
MEMM4623Medicare PIN
MEF45909Medicare UPIN