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Individual

DERRICK S TOOTH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1053 WESTERN AVE, MANCHESTER, ME 04351-3403
(207) 622-6319
(207) 622-6654
Mailing address
9 PLEASANT STREET, SUITE 2, OAKLAND, ME 04963
(207) 465-2700
(207) 465-2300

Taxonomy

Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
014663
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
030440
ANTHEM
ME
01
1041053
AETNA
05
255890099
ME
Enumeration date
09/27/2006
Last updated
12/05/2012
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