Basic Information
| Provider Information | |||||||||
| NPI: | 1982647764 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRASK-EATON | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | |||||||||
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| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 468 | ||||||||
| Address2: | |||||||||
| City: | SKOWHEGAN | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049760468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078588353 | ||||||||
| FaxNumber: | 2074749261 | ||||||||
| Practice Location | |||||||||
| Address1: | 87 MERCER RD | ||||||||
| Address2: | |||||||||
| City: | NORRIDGEWOCK | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049573168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076344366 | ||||||||
| FaxNumber: | 2076344375 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 12/11/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/11/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 1933 | ME | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | DO1933 | ME | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1982647764 | 05 | ME | MEDICAID |