Provider Demographics
NPI:1821192113
Name:SIMMONS, MILES A (MD)
Entity Type:Individual
Prefix:
First Name:MILES
Middle Name:A
Last Name:SIMMONS
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 1:169 PARK ROW
Mailing Address - Street 2:SUITE 7
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2039
Mailing Address - Country:US
Mailing Address - Phone:207-729-5426
Mailing Address - Fax:207-725-2473
Practice Address - Street 1:169 PARK ROW
Practice Address - Street 2:SUITE 7
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011
Practice Address - Country:US
Practice Address - Phone:207-729-5426
Practice Address - Fax:207-725-2473
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0128012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME234080099Medicaid
E004219OtherTRICARE
003576OtherANTNEM
78246OtherCIGNA
78246OtherCIGNA
MM3412Medicare ID - Type Unspecified