Provider Demographics
NPI:1154425403
Name:CONSTANTINE, JOSEPH M (DPM)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:M
Last Name:CONSTANTINE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HAMMOND ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401
Mailing Address - Country:US
Mailing Address - Phone:207-942-9301
Mailing Address - Fax:207-942-9301
Practice Address - Street 1:300 HAMMOND ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-942-9301
Practice Address - Fax:207-942-9301
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD135213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME107220000Medicaid
ME000357OtherBLUE CROSS
480033731OtherPALMETTO GBA
480033731OtherPALMETTO GBA
ME107220000Medicaid