MEDICARE: BURTON KNAPP 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	207Q00000X	Family Medicine Physician	008531	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	:	1598794786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BURTON KNAPP M.D.

Provider Business Mailing Address
First Line	:	42 DALLAS HILL RD
Second Line	:
City	:	RANGELEY
State	:	ME
Zip	:	04970-0569
Country	:	US
Telephone Number	:	207-864-2699
Fax Number	:	207-864-2969

Provider Business Practice Location Address
First Line	:	42 DALLAS HILL RD
Second Line	:
City	:	RANGELEY
State	:	ME
Zip	:	04970-0569
Country	:	US
Telephone Number	:	107-864-2699
Fax Number	:	207-864-2969

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

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	03/11/2010

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