Provider Demographics
NPI:1841262417
Name:BARTOL, THOMAS G (NP)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:G
Last Name:BARTOL
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 GARDINER ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:ME
Mailing Address - Zip Code:04357
Mailing Address - Country:US
Mailing Address - Phone:207-737-4359
Mailing Address - Fax:207-737-4412
Practice Address - Street 1:24 GARDINER ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:ME
Practice Address - Zip Code:04357
Practice Address - Country:US
Practice Address - Phone:207-737-4359
Practice Address - Fax:207-737-4412
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME42208363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME325810099Medicaid
P07925Medicare UPIN
ME325810099Medicaid