Provider Demographics
NPI:1205943388
Name:HARMON, NATHAN R (DO)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:R
Last Name:HARMON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 GLENRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-6606
Mailing Address - Country:US
Mailing Address - Phone:207-626-2600
Mailing Address - Fax:207-621-0277
Practice Address - Street 1:40 GLENRIDGE DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-6606
Practice Address - Country:US
Practice Address - Phone:207-626-2600
Practice Address - Fax:207-621-0277
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2052207Q00000X, 208M00000X, 207P00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432681999Medicaid
ME432681999Medicaid
ME000690701Medicare PIN
ME000690702Medicare PIN