1740263433 NPI number — DR. VILLI PETERS ENDERS MD

Table of content: SAMER M BASHITI D.O. (NPI 1770744831)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740263433 NPI number — DR. VILLI PETERS ENDERS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ENDERS
Provider First Name:
VILLI
Provider Middle Name:
PETERS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740263433
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 810
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTBROOK
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04098-0810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-854-1544
Provider Business Mailing Address Fax Number:
207-854-1516

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
53 SEWALL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04102-2625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-828-2020
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  012829 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207L00000X , with the licence number: 147526-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: MD-052485-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 218470000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1740263433 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 006187 . This is a "ANTHEM OF MAINE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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