Provider Demographics
NPI:1316034887
Name:BOTHFELD, RICHARD WENDELL (AUD, F-AAA, C-AAA)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WENDELL
Last Name:BOTHFELD
Suffix:
Gender:M
Credentials:AUD, F-AAA, C-AAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 WATER ST
Mailing Address - Street 2:
Mailing Address - City:GARDINER
Mailing Address - State:ME
Mailing Address - Zip Code:04345-2159
Mailing Address - Country:US
Mailing Address - Phone:207-481-9900
Mailing Address - Fax:207-536-5306
Practice Address - Street 1:312 WATER ST
Practice Address - Street 2:
Practice Address - City:GARDINER
Practice Address - State:ME
Practice Address - Zip Code:04345-2159
Practice Address - Country:US
Practice Address - Phone:207-481-9900
Practice Address - Fax:207-536-5306
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP1990231HA2500X, 231H00000X, 237600000X
NHA441237600000X, 231H00000X, 231HA2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009099Medicaid
NH30210958Medicaid
ME001558401Medicare PIN
NH019064Medicare ID - Type UnspecifiedMEDICARE B