Provider Demographics
NPI:1467552760
Name:NAUSS, ALAN H (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:H
Last Name:NAUSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 GRINDSTONE AVE.
Mailing Address - Street 2:
Mailing Address - City:WINTER HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04693
Mailing Address - Country:US
Mailing Address - Phone:207-963-5512
Mailing Address - Fax:
Practice Address - Street 1:604 GRINDSTONE AVE.
Practice Address - Street 2:
Practice Address - City:WINTER HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04693
Practice Address - Country:US
Practice Address - Phone:207-963-5512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA32672208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6167322Medicaid
A68124Medicare UPIN
M07801Medicare ID - Type Unspecified