Provider Demographics
NPI:1629274543
Name:SCRIVEN, TERRY ANN (MD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:ANN
Last Name:SCRIVEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6233
Mailing Address - Street 2:18 OLD OCEAN HOUSE ROAD
Mailing Address - City:CAPE ELIZABETH
Mailing Address - State:ME
Mailing Address - Zip Code:04107-0033
Mailing Address - Country:US
Mailing Address - Phone:207-699-0901
Mailing Address - Fax:207-699-0902
Practice Address - Street 1:1226 SHORE RD
Practice Address - Street 2:
Practice Address - City:CAPE ELIZABETH
Practice Address - State:ME
Practice Address - Zip Code:04107-2123
Practice Address - Country:US
Practice Address - Phone:207-699-0901
Practice Address - Fax:207-699-0902
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME013535207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM486603OtherPTAN
MEMM486602Medicare PIN
ME1629274543Medicare PIN