Provider Demographics
NPI:1609817055
Name:PIERCE, ELIZABETH B (DO)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:B
Last Name:PIERCE
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 1:60 FOREST FALLS DR
Mailing Address - Street 2:STE 5
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-6971
Mailing Address - Country:US
Mailing Address - Phone:207-847-9200
Mailing Address - Fax:207-847-9315
Practice Address - Street 1:60 FOREST FALLS DR
Practice Address - Street 2:STE 5
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-6971
Practice Address - Country:US
Practice Address - Phone:207-847-9200
Practice Address - Fax:207-847-3501
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1563207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080193647OtherMEDICARE RAILROAD
5599661OtherAETNA PROVIDER ID
5599661OtherAETNA PROVIDER ID
G78706Medicare UPIN