Provider Demographics
NPI:1467556548
Name:O'NEILL, NANCY THERESA (MD)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:THERESA
Last Name:O'NEILL
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 1:106 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARS HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04758-3403
Mailing Address - Country:US
Mailing Address - Phone:207-429-8333
Mailing Address - Fax:
Practice Address - Street 1:106 MAIN ST
Practice Address - Street 2:
Practice Address - City:MARS HILL
Practice Address - State:ME
Practice Address - Zip Code:04758-3403
Practice Address - Country:US
Practice Address - Phone:207-429-8333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00012627207Q00000X
ME011780207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009933156Medicaid
AL051001880OtherBCBS
ME271860099Medicaid
AL051001880OtherBCBS
ME271860099Medicaid
MM761301Medicare PIN