Provider Demographics
NPI:1427096098
Name:DEMICCO, WILLIAM ANDREW (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ANDREW
Last Name:DEMICCO
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 1:144 STATE ST
Mailing Address - Street 2:MERCY HOSPITAL
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101
Mailing Address - Country:US
Mailing Address - Phone:207-879-3899
Mailing Address - Fax:207-879-3991
Practice Address - Street 1:144 STATE ST
Practice Address - Street 2:MERCY HOSPITAL
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101
Practice Address - Country:US
Practice Address - Phone:207-879-3899
Practice Address - Fax:207-879-3991
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME009408207RP1001X
ME9408207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEB86574Medicare UPIN
015315Medicare PIN
B86574Medicare UPIN