Provider Demographics
NPI:1942289657
Name:GUSHUE, TRISHA A (DO)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:A
Last Name:GUSHUE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 CHURCH HILL RD STE 1
Mailing Address - Street 2:
Mailing Address - City:LEEDS
Mailing Address - State:ME
Mailing Address - Zip Code:04263-3418
Mailing Address - Country:US
Mailing Address - Phone:207-524-3501
Mailing Address - Fax:207-647-4000
Practice Address - Street 1:25 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-1167
Practice Address - Country:US
Practice Address - Phone:207-524-3501
Practice Address - Fax:207-647-4000
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1534207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME243860099Medicaid
ME001904201Medicare UPIN
MEG47561Medicare UPIN
ME243860099Medicaid