Provider Demographics
NPI:1912913641
Name:THIEME, VICTORIA S (DO)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:S
Last Name:THIEME
Suffix:
Gender:F
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:PO BOX 6071
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-6071
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21 TWIN POND RD
Practice Address - Street 2:
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086
Practice Address - Country:US
Practice Address - Phone:207-725-1823
Practice Address - Fax:207-805-9484
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1460204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME311260099Medicaid
MEME0630Medicare ID - Type Unspecified
ME311260099Medicaid