1376510057 NPI number — GORDON THOMPSON CALDWELL JR. MD

Table of content: GORDON THOMPSON CALDWELL JR. MD (NPI 1376510057)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376510057 NPI number — GORDON THOMPSON CALDWELL JR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CALDWELL
Provider First Name:
GORDON
Provider Middle Name:
THOMPSON
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
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:
1376510057
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
77 BATES ST
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
LEWISTON
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04240-7637
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-783-2300
Provider Business Mailing Address Fax Number:
207-783-2439

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
77 BATES ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
LEWISTON
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04240-7637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-783-2300
Provider Business Practice Location Address Fax Number:
207-783-2439
Provider Enumeration Date:
03/02/2006

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: 208VP0000X , with the licence number:  012721 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 030495 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010424957 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: M52001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: E19633 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010424957 . This is a "EMPLOY STANDARDS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010424957 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2075723 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 25012128 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 272410099 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010424957 . This is a "STANDARD TAX ID" identifier . This identifiers is of the category "OTHER".




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