Provider Demographics
NPI:1891854931
Name:DOUGLAS O'HEIR, D.P.M.
Entity Type:Organization
Organization Name:DOUGLAS O'HEIR, D.P.M.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:O'HEIR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:207-872-2262
Mailing Address - Street 1:143 SILVER ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5833
Mailing Address - Country:US
Mailing Address - Phone:207-872-2262
Mailing Address - Fax:207-872-8411
Practice Address - Street 1:143 SILVER ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-5833
Practice Address - Country:US
Practice Address - Phone:207-872-2262
Practice Address - Fax:207-872-8411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD175213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME5528251OtherAETNA
ME1891854931OtherMEDICARE GROUP NPI
MM6649OtherMEDICARE GROUP PTAN
ME114490099Medicaid
ME480002906OtherRAIL ROAD MEDICARE
ME002205OtherANTHEM
MEM53560OtherCIGNA
ME002205OtherANTHEM
01560801Medicare PIN
MM6649OtherMEDICARE GROUP PTAN
MET31461Medicare UPIN