Provider Demographics
NPI:1376973651
Name:MERIDETH C NORRIS PA
Entity Type:Organization
Organization Name:MERIDETH C NORRIS PA
Other - Org Name:GRACEFUL RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MERIDETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-604-5034
Mailing Address - Street 1:58 PORTLAND RD
Mailing Address - Street 2:SUITE 18
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-6656
Mailing Address - Country:US
Mailing Address - Phone:207-604-5034
Mailing Address - Fax:
Practice Address - Street 1:58 PORTLAND RD
Practice Address - Street 2:SUITE 18
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6656
Practice Address - Country:US
Practice Address - Phone:207-604-5034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-22
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1813207Q00000X, 208VP0000X
MEME1813207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME280670099Medicaid
MEE100136968OtherETAN
MEME0213Medicare PIN
H96260Medicare UPIN