Provider Demographics
NPI:1467483859
Name:GARRETT, AUDREY MERRILL (MD)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:MERRILL
Last Name:GARRETT
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 1:43 WHITING HILL RD
Mailing Address - Street 2:STE 300
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1005
Mailing Address - Country:US
Mailing Address - Phone:207-973-5035
Mailing Address - Fax:207-973-5042
Practice Address - Street 1:33 WHITING HILL RD
Practice Address - Street 2:SUITE 21
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-1021
Practice Address - Country:US
Practice Address - Phone:207-973-7478
Practice Address - Fax:207-973-8707
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013988207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM596802OtherMEDICARE B - BLUE HILL MEMORIAL HOSPITAL
MEMM596802OtherMEDICARE B - BLUE HILL MEMORIAL HOSPITAL
G13188Medicare UPIN