MEDICARE: GERALD FAY WESTOVER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician	MD19269	ME
2	207R00000X	Internal Medicine Physician	MD19269	ME

General Provider Information

NPI Number	:	1033107933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALD FAY WESTOVER M.D.

Provider Business Mailing Address
First Line	:	4 GLEN COVE DR
Second Line	:	SUITE 5
City	:	ROCKPORT
State	:	ME
Zip	:	04856-4235
Country	:	US
Telephone Number	:	207-593-5883
Fax Number	:	207-593-5302

Provider Business Practice Location Address
First Line	:	4 GLEN COVE DR
Second Line	:	SUITE 5
City	:	ROCKPORT
State	:	ME
Zip	:	04856-4235
Country	:	US
Telephone Number	:	207-593-5883
Fax Number	:	207-593-5302

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	12/24/2013

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