Individual
PATRICE M THIBODEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
DR.0054626
CO
208000000X
Pediatrics Physician
MD15542
ME
2080A0000X
Pediatric Adolescent Medicine Physician
DR.0054626
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
378538YY4G
PTAN
CO
01
—
C544638
EMPLOYER PTAN
CO
Enumeration date
10/04/2006
Last updated
01/15/2015
Update your record
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