Provider Demographics
NPI:1215967245
Name:DEMARS, CARL S (MD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:S
Last Name:DEMARS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:ME
Mailing Address - Zip Code:04530-2550
Mailing Address - Country:US
Mailing Address - Phone:207-386-1800
Mailing Address - Fax:207-442-9822
Practice Address - Street 1:108 CENTRE ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530-2550
Practice Address - Country:US
Practice Address - Phone:207-373-1800
Practice Address - Fax:207-442-9822
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME015294207RA0000X
MEMD15294207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
10902369OtherCAQH
MEH20587Medicare UPIN
H20587Medicare UPIN
MX8070Medicare PIN