Provider Demographics
NPI:1386640258
Name:HUMPHRIES, SUZANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:
Last Name:HUMPHRIES
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 300
Mailing Address - Street 2:
Mailing Address - City:LINCOLNVILLE CENTER
Mailing Address - State:ME
Mailing Address - Zip Code:04850-0300
Mailing Address - Country:US
Mailing Address - Phone:207-342-2688
Mailing Address - Fax:
Practice Address - Street 1:435 MUZZY RIDGE RD
Practice Address - Street 2:
Practice Address - City:SEARSMONT
Practice Address - State:ME
Practice Address - Zip Code:04973-3202
Practice Address - Country:US
Practice Address - Phone:207-342-2688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME015655207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME303480099Medicaid
ME303480099Medicaid
MEG76016Medicare UPIN