MEDICARE: DR. EDWARD JOHN BILOTTI 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	2084P0800X	Psychiatry Physician	MD19190	ME

General Provider Information

NPI Number	:	1740344902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD JOHN BILOTTI MD

Provider Business Mailing Address
First Line	:	PO BOX 2278
Second Line	:
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04116-2278
Country	:	US
Telephone Number	:	908-240-3106
Fax Number	:	207-747-5129

Provider Business Practice Location Address
First Line	:	16 ATLANTIC PL
Second Line	:
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106-2316
Country	:	US
Telephone Number	:	908-240-3106
Fax Number	:	207-747-5129

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

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	01/18/2019

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