Healthcare Provider Details

I. General information

NPI: 1740263433
Provider Name (Legal Business Name): VILLI PETERS ENDERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 03/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 SEWALL ST
PORTLAND ME
04102-2625
US

IV. Provider business mailing address

PO BOX 810
WESTBROOK ME
04098-0810
US

V. Phone/Fax

Practice location:
  • Phone: 207-828-2020
  • Fax:
Mailing address:
  • Phone: 207-854-1544
  • Fax: 207-854-1516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number012829
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number147526-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD-052485-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: