Healthcare Provider Details

I. General information

NPI: 1932175742
Provider Name (Legal Business Name): PETER A DEWOLFE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 10/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 MAIN ST SUITE 2A
WINTHROP ME
04364-1462
US

IV. Provider business mailing address

149 MAIN ST STE 2A
WINTHROP ME
04364-1486
US

V. Phone/Fax

Practice location:
  • Phone: 207-624-3800
  • Fax: 207-624-3845
Mailing address:
  • Phone: 207-624-3800
  • Fax: 207-624-3845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number012147
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: