Provider Demographics
NPI:1134219801
Name:CURTIS, THEODORE (MD)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:
Last Name:CURTIS
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 1:43 WHITING HILL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1006
Mailing Address - Country:US
Mailing Address - Phone:207-973-5000
Mailing Address - Fax:207-973-5042
Practice Address - Street 1:885 UNION ST
Practice Address - Street 2:SUITE 120/130
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-973-8876
Practice Address - Fax:207-973-6058
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43728207W00000X
WAMD60035767207W00000X
NY259317207W00000X
ME24367207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY259317OtherLICENSE
NY03401952Medicaid
WAMD60035767OtherLICENSE
WAMD60035767OtherLICENSE
NY03401952Medicaid
WA0594300002Medicare NSC
WAMD60035767OtherLICENSE
000681806Medicare PIN