Provider Demographics
NPI:1740239466
Name:FREY, THOMAS M (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:FREY
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 1:417 STATE ST
Mailing Address - Street 2:STE 400
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6690
Mailing Address - Country:US
Mailing Address - Phone:207-973-8852
Mailing Address - Fax:207-973-8857
Practice Address - Street 1:417 STATE ST
Practice Address - Street 2:STE 400
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6690
Practice Address - Country:US
Practice Address - Phone:207-942-6096
Practice Address - Fax:207-973-8857
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013128207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME268410099Medicaid
ME000561OtherBLUE CROSS
ME110046891OtherRAILROAD MEDICARE
MEMM3486Medicare ID - Type Unspecified
ME268410099Medicaid