Provider Demographics
NPI:1982647764
Name:TRASK-EATON, EMILY (DO)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:TRASK-EATON
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 468
Mailing Address - Street 2:
Mailing Address - City:SKOWHEGAN
Mailing Address - State:ME
Mailing Address - Zip Code:04976-0468
Mailing Address - Country:US
Mailing Address - Phone:207-858-8353
Mailing Address - Fax:207-474-9261
Practice Address - Street 1:87 MERCER RD
Practice Address - Street 2:
Practice Address - City:NORRIDGEWOCK
Practice Address - State:ME
Practice Address - Zip Code:04957-3168
Practice Address - Country:US
Practice Address - Phone:207-634-4366
Practice Address - Fax:207-634-4375
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1933207Q00000X
MEDO1933207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1982647764Medicaid
ME432210299Medicaid