Provider Demographics
NPI:1891819603
Name:REIGHT, IAN G (MD)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:G
Last Name:REIGHT
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 1:12 HIGH ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04243
Mailing Address - Country:US
Mailing Address - Phone:207-795-5767
Mailing Address - Fax:207-795-2319
Practice Address - Street 1:12 HIGH ST
Practice Address - Street 2:SUITE 401
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04243
Practice Address - Country:US
Practice Address - Phone:207-795-5767
Practice Address - Fax:207-795-2319
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL 26254208600000X
ME017935208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME43307099Medicaid
ME00794701Medicare PIN