Provider Demographics
NPI:1720297500
Name:ESPONNETTE, PETER KENNETH (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:KENNETH
Last Name:ESPONNETTE
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 1:20 BRAMBLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-9200
Mailing Address - Country:US
Mailing Address - Phone:207-777-5383
Mailing Address - Fax:
Practice Address - Street 1:CONCENTRA
Practice Address - Street 2:59 EAST AVE.
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240
Practice Address - Country:US
Practice Address - Phone:207-784-1680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME13030208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation