Provider Demographics
NPI:1427062728
Name:KITFIELD, EDWARD B III (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:B
Last Name:KITFIELD
Suffix:III
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:PO BOX 351
Mailing Address - Street 2:
Mailing Address - City:WISCASSET
Mailing Address - State:ME
Mailing Address - Zip Code:04578-4133
Mailing Address - Country:US
Mailing Address - Phone:207-882-6008
Mailing Address - Fax:208-882-7803
Practice Address - Street 1:66 WATER STR
Practice Address - Street 2:
Practice Address - City:WISCASSET
Practice Address - State:ME
Practice Address - Zip Code:04578-4133
Practice Address - Country:US
Practice Address - Phone:207-882-6008
Practice Address - Fax:208-882-7803
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME008477207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME108450199Medicaid
ME07371702Medicare PIN
MEDO3797Medicare UPIN