MEDICARE: JOHN MARLEY DICKENS MD

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	208D00000X	General Practice Physician	11529	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437159233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN MARLEY DICKENS MD

Provider Business Mailing Address
First Line	:	PO BOX 680
Second Line	:
City	:	WALDOBORO
State	:	ME
Zip	:	04572-0680
Country	:	US
Telephone Number	:	207-832-6394
Fax Number	:	207-832-4392

Provider Business Practice Location Address
First Line	:	592 W MAIN ST
Second Line	:
City	:	WALDOBORO
State	:	ME
Zip	:	04572-6030
Country	:	US
Telephone Number	:	207-832-6394
Fax Number	:	207-832-4392

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	03/07/2023

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