Provider Demographics
NPI:1376680942
Name:CYR, PHILIP STEPHEN
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:STEPHEN
Last Name:CYR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:EDDINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04428-3114
Mailing Address - Country:US
Mailing Address - Phone:207-989-9789
Mailing Address - Fax:207-989-5790
Practice Address - Street 1:97 SILK ST
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-1862
Practice Address - Country:US
Practice Address - Phone:207-989-5790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEALLS2183171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME200970000Medicaid