Provider Demographics
NPI:1689631392
Name:TOCKMAN, RICHARD S (MD)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:S
Last Name:TOCKMAN
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:PO BOX 233
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-0233
Mailing Address - Country:US
Mailing Address - Phone:207-490-7728
Mailing Address - Fax:207-490-7069
Practice Address - Street 1:25A JUNE ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-2642
Practice Address - Country:US
Practice Address - Phone:207-324-8311
Practice Address - Fax:207-324-7899
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME009388207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEB86997OtherHARVARD PILGRIM
ME2071103OtherAETNA
ME321290199Medicaid
ME025354OtherANTHEM
ME610109201OtherCIGNA
ME135967Medicare ID - Type Unspecified
B86997Medicare UPIN