Healthcare Provider Details

I. General information

NPI: 1295732097
Provider Name (Legal Business Name): RONALD H PROKOPIUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 10/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 WATER STREET
BLUE HILL ME
04614
US

IV. Provider business mailing address

57 WATER STREET
BLUE HILL ME
04614
US

V. Phone/Fax

Practice location:
  • Phone: 207-374-3933
  • Fax: 207-374-3985
Mailing address:
  • Phone: 207-374-3933
  • Fax: 207-374-3985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD16554
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: