Provider Demographics
NPI:1831202134
Name:SAMMIS, CYNTHIA (MD)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:SAMMIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:MACHIAS
Mailing Address - State:ME
Mailing Address - Zip Code:04654-1320
Mailing Address - Country:US
Mailing Address - Phone:207-255-8290
Mailing Address - Fax:207-255-4109
Practice Address - Street 1:53 FREMONT ST
Practice Address - Street 2:
Practice Address - City:MACHIAS
Practice Address - State:ME
Practice Address - Zip Code:04654-1320
Practice Address - Country:US
Practice Address - Phone:207-255-8290
Practice Address - Fax:207-255-4109
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME011620207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME292980099Medicaid
ME292980099Medicaid
MEB86628Medicare UPIN