1548252877 NPI number — DR. JOEL S OLSTEIN MD

Table of content: DR. JOEL S OLSTEIN MD (NPI 1548252877)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548252877 NPI number — DR. JOEL S OLSTEIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLSTEIN
Provider First Name:
JOEL
Provider Middle Name:
S
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:
1548252877
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/27/2006
NPI Reactivation Date:
04/03/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1638
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12201-1638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-777-4111
Provider Business Mailing Address Fax Number:
207-783-6660

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
99 CAMPUS AVE
Provider Second Line Business Practice Location Address:
SUITE 401
Provider Business Practice Location Address City Name:
LEWISTON
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04240-6045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-755-3150
Provider Business Practice Location Address Fax Number:
207-755-3155
Provider Enumeration Date:
08/23/2005

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: 208800000X , with the licence number:  008973 , 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: 109510000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




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