Provider Demographics
NPI:1528065208
Name:YATES, CALVIN C (MD)
Entity type:Individual
Prefix:
First Name:CALVIN
Middle Name:C
Last Name:YATES
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 1:5 MILES CENTER WAY
Mailing Address - Street 2:UNIT 1
Mailing Address - City:DAMARISCOTTA
Mailing Address - State:ME
Mailing Address - Zip Code:04543-4067
Mailing Address - Country:US
Mailing Address - Phone:207-563-4250
Mailing Address - Fax:207-563-4246
Practice Address - Street 1:5 MILES CENTER WAY
Practice Address - Street 2:UNIT 1
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543-4067
Practice Address - Country:US
Practice Address - Phone:207-563-4250
Practice Address - Fax:207-563-4246
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013951208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME3314000996Medicaid
C65880Medicare UPIN
ME3314000996Medicaid