Basic Information
| Provider Information | |||||||||
| NPI: | 1164498630 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAKIAM | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 56 WINTHROP ST | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | ME | ||||||||
| PostalCode: | 043305501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076260481 | ||||||||
| FaxNumber: | 2076226078 | ||||||||
| Practice Location | |||||||||
| Address1: | 56 WINTHROP ST | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | ME | ||||||||
| PostalCode: | 043305501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076260481 | ||||||||
| FaxNumber: | 2076226078 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2006 | ||||||||
| LastUpdateDate: | 03/28/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 015247 | ME | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 133200099 | 05 | ME | MEDICAID |