Basic Information
| Provider Information | |||||||||
| NPI: | 1710963434 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THIEME | ||||||||
| FirstName: | RALPH | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6071 | ||||||||
| Address2: | |||||||||
| City: | FALMOUTH | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041056071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077816560 | ||||||||
| FaxNumber: | 2078392197 | ||||||||
| Practice Location | |||||||||
| Address1: | 6 FUNDY RD STE 400 | ||||||||
| Address2: | |||||||||
| City: | FALMOUTH | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041051780 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077811500 | ||||||||
| FaxNumber: | 2078392197 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2005 | ||||||||
| LastUpdateDate: | 05/04/2015 | ||||||||
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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 | 204D00000X | 1596 | ME | Y | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine & OMM |
ID Information
| ID | Type | State | Issuer | Description | 3443842 | 01 | ME | AETNA | OTHER | 4336070 | 01 | ME | CIGNA | OTHER | AA5728 | 01 | ME | HARVARD PILGRIM | OTHER | 326760000 | 05 | ME | MEDICAID | 047280 | 01 | ME | ANTHEM | OTHER |