Provider Demographics
NPI:1720226244
Name:KAPSHA, ELYSIA IRWIN (DO)
Entity Type:Individual
Prefix:DR
First Name:ELYSIA
Middle Name:IRWIN
Last Name:KAPSHA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ELYSIA
Other - Middle Name:DEBORAH
Other - Last Name:IRWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:354 AIRPORT ROAD
Mailing Address - Street 2:
Mailing Address - City:STONINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04681
Mailing Address - Country:US
Mailing Address - Phone:207-367-2311
Mailing Address - Fax:207-367-2805
Practice Address - Street 1:354 AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:STONINGTON
Practice Address - State:ME
Practice Address - Zip Code:04681
Practice Address - Country:US
Practice Address - Phone:207-367-2311
Practice Address - Fax:207-367-2805
Is Sole Proprietor?:No
Enumeration Date:2009-01-22
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2182207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME001938501Medicare PIN