Provider Demographics
NPI:1821142472
Name:THURSTON, DUSKA JOY (MD)
Entity Type:Individual
Prefix:
First Name:DUSKA
Middle Name:JOY
Last Name:THURSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DUSKA
Other - Middle Name:JOY
Other - Last Name:THURSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:43 WHITING HILL RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1005
Mailing Address - Country:US
Mailing Address - Phone:207-973-5035
Mailing Address - Fax:207-973-5042
Practice Address - Street 1:895 UNION ST
Practice Address - Street 2:SUITE 12
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3053
Practice Address - Country:US
Practice Address - Phone:207-973-7979
Practice Address - Fax:207-947-9579
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036963208000000X
MEMD19312208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1821142472Medicaid
WA0246MCOtherREGENCE
WA0264223OtherL&I AND CRIME VICTIMS
WA0264223OtherL&I AND CRIME VICTIMS