Healthcare Provider Details

I. General information

NPI: 1518944487
Provider Name (Legal Business Name): ANTHONY VANDYCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 FAIRVIEW AVE
SKOWHEGAN ME
04976-1481
US

IV. Provider business mailing address

PO BOX 468
SKOWHEGAN ME
04976-0468
US

V. Phone/Fax

Practice location:
  • Phone: 207-474-5121
  • Fax: 207-474-9256
Mailing address:
  • Phone: 207-474-5121
  • Fax: 207-474-9256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD15847
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number015847
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: