Provider Demographics
NPI:1932175742
Name:DEWOLFE, PETER A (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:A
Last Name:DEWOLFE
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 1:149 MAIN ST
Mailing Address - Street 2:STE 2A
Mailing Address - City:WINTHROP
Mailing Address - State:ME
Mailing Address - Zip Code:04364-1486
Mailing Address - Country:US
Mailing Address - Phone:207-624-3800
Mailing Address - Fax:207-624-3845
Practice Address - Street 1:149 MAIN ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:WINTHROP
Practice Address - State:ME
Practice Address - Zip Code:04364-1462
Practice Address - Country:US
Practice Address - Phone:207-624-3800
Practice Address - Fax:207-624-3845
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME012147207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME060036929Medicare PIN
MEB86396Medicare UPIN
MEMM0731Medicare ID - Type Unspecified
ME320010099Medicare ID - Type Unspecified
MEMM073101Medicare PIN