Basic Information
| Provider Information | |||||||||
| NPI: | 1689631392 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TOCKMAN | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 233 | ||||||||
| Address2: | |||||||||
| City: | SANFORD | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040730233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074907728 | ||||||||
| FaxNumber: | 2074907069 | ||||||||
| Practice Location | |||||||||
| Address1: | 25A JUNE ST | ||||||||
| Address2: | |||||||||
| City: | SANFORD | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040732642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2073248311 | ||||||||
| FaxNumber: | 2073247899 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207Q00000X | 009388 | ME | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | B86997 | 01 | ME | HARVARD PILGRIM | OTHER | 2071103 | 01 | ME | AETNA | OTHER | 321290199 | 05 | ME | MEDICAID | 025354 | 01 | ME | ANTHEM | OTHER | 610109201 | 01 | ME | CIGNA | OTHER |