Basic Information
| Provider Information | |||||||||
| NPI: | 1598866188 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COMMONS | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12 HIGH ST | ||||||||
| Address2: | STE 200 | ||||||||
| City: | LEWISTON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 042407676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077955770 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12 HIGH ST | ||||||||
| Address2: | STE 200 | ||||||||
| City: | LEWISTON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 042407676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077955770 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2006 | ||||||||
| LastUpdateDate: | 01/02/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 015063 | ME | N | Other Service Providers | Specialist | 207V00000X | MD15063 | ME | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.