Provider Demographics
NPI:1487837894
Name:ALLAN W NYMAN DPM PA
Entity Type:Organization
Organization Name:ALLAN W NYMAN DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:NYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM PA
Authorized Official - Phone:207-873-2683
Mailing Address - Street 1:316 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4921
Mailing Address - Country:US
Mailing Address - Phone:207-873-2683
Mailing Address - Fax:
Practice Address - Street 1:316 MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4921
Practice Address - Country:US
Practice Address - Phone:207-873-2683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD136213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
601659OtherM'CARE GROUP NO.
ME000591OtherANTHEM
ME152624Medicare PIN
601659OtherM'CARE GROUP NO.