Frederick K Thaler, MD
Individual provider Active NPI Family Medicine Physician · Kitter, ME
NPI 1649362005 · NPPES record last updated Jul 9, 2010
Key facts
- NPI
- 1649362005
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 010272 (ME)
- Practice address
- 22 Shapleigh Road
Kitter, ME 03904 - Phone
- (207) 439-4430
- Fax
- (207) 439-0968
- NPI assigned
- Sep 29, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 010272 | ME | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 010272 | ME | Yes |
Addresses
Primary practice location
22 Shapleigh Road
Kitter, ME 03904
Mailing address
22 Shapleigh Rd
Kittery, ME 03904-1455
Phone (207) 439-4430
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 29910099 | Medicaid | ME |
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.