Provider Demographics
NPI:1205060225
Name:MAGNER, ANN K (DO)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:K
Last Name:MAGNER
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:301C US RT 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:66 BRAMHALL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102
Practice Address - Country:US
Practice Address - Phone:207-662-3157
Practice Address - Fax:207-662-4257
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2013-10-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MED02298207RG0300X
MEDO2298207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME003381403Medicare PIN
ME003381401Medicare PIN
ME003381402Medicare PIN