1639183718 NPI number — DR. DONALD G CVITKOVICH MD

Table of content: DR. DONALD G CVITKOVICH MD (NPI 1639183718)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639183718 NPI number — DR. DONALD G CVITKOVICH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CVITKOVICH
Provider First Name:
DONALD
Provider Middle Name:
G
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:
1639183718
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12 HOSPITAL DR
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
YORK
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
03909-1030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-351-3715
Provider Business Mailing Address Fax Number:
207-351-3716

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
03909-1030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-351-3715
Provider Business Practice Location Address Fax Number:
207-351-3716
Provider Enumeration Date:
07/27/2006

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: 207RP1001X , with the licence number:  015930 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RP1001X , with the licence number: 51173-20 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 041670 . This is a "BC/BS" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 01Y004052ME01 . This is a "NH BC/BS" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 753075422 . This is a "MILITARY HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2885154 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: M21490 . This is a "CIGNA HEATHSOURCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 189500000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2233094 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: D95576 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".




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