Provider Demographics
NPI:1942373733
Name:HAMMOND, SU ANNE (DO)
Entity Type:Individual
Prefix:
First Name:SU ANNE
Middle Name:
Last Name:HAMMOND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 TANDBERG TRL UNIT 6
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-6417
Mailing Address - Country:US
Mailing Address - Phone:207-544-4564
Mailing Address - Fax:207-407-7332
Practice Address - Street 1:32 TANDBERG TRL UNIT 6
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-6417
Practice Address - Country:US
Practice Address - Phone:207-544-4564
Practice Address - Fax:207-407-7332
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1883207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME6318152OtherCIGNA
ME1423834OtherAETNA
ME099032OtherANTHEM
ME432556199Medicaid
MESX4978Medicare PIN
MEI71193Medicare UPIN