Provider Demographics
NPI:1386604056
Name:SCHENK, ERIC RICHARD (DO)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:RICHARD
Last Name:SCHENK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 COMMERCIAL ST STE D
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-5964
Mailing Address - Country:US
Mailing Address - Phone:207-230-8220
Mailing Address - Fax:207-230-8346
Practice Address - Street 1:247 COMMERCIAL ST STE D
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-5964
Practice Address - Country:US
Practice Address - Phone:207-230-8220
Practice Address - Fax:207-230-8346
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1871207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME5641527OtherFIRST HEALTH
ME061334OtherANTHEM
MEAA35830OtherHARVARD PILGRIM
ME3825048OtherAETNA
ME431872600Medicaid
ME5641527OtherFIRST HEALTH
ME431872600Medicaid