Provider Demographics
NPI:1679829212
Name:THAO, DAVID (DPM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:THAO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 S PATTEN RD
Mailing Address - Street 2:
Mailing Address - City:PATTEN
Mailing Address - State:ME
Mailing Address - Zip Code:04765-3007
Mailing Address - Country:US
Mailing Address - Phone:207-528-2285
Mailing Address - Fax:207-528-2880
Practice Address - Street 1:529 S PATTEN RD
Practice Address - Street 2:
Practice Address - City:PATTEN
Practice Address - State:ME
Practice Address - Zip Code:04765-3007
Practice Address - Country:US
Practice Address - Phone:207-528-2285
Practice Address - Fax:207-528-2880
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD1101213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery