Provider Demographics
NPI:1003805995
Name:WHITAKER, MARTIN D (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:D
Last Name:WHITAKER
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 1:193 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORWAY
Mailing Address - State:ME
Mailing Address - Zip Code:04268-5645
Mailing Address - Country:US
Mailing Address - Phone:207-743-0027
Mailing Address - Fax:207-743-0051
Practice Address - Street 1:193 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04268-5645
Practice Address - Country:US
Practice Address - Phone:207-743-0027
Practice Address - Fax:207-743-0051
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME015596207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME3739577OtherAETNA
ME061139OtherANTHEM BLUE CROSS
ME325120099Medicaid
MEM2307901OtherCIGNA
MEP00184354OtherRAILROAD MEDICARE
ME431545400Medicaid
ME325120099Medicaid
ME061139OtherANTHEM BLUE CROSS