Provider Demographics
NPI:1225057565
Name:DIMARTINIS, JILL CHARLOTTE (MD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:CHARLOTTE
Last Name:DIMARTINIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:51 US ROUTE 1 STE A
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7145
Mailing Address - Country:US
Mailing Address - Phone:207-396-1440
Mailing Address - Fax:207-289-3104
Practice Address - Street 1:112 SANFORD RD
Practice Address - Street 2:
Practice Address - City:WELLS
Practice Address - State:ME
Practice Address - Zip Code:04090-5533
Practice Address - Country:US
Practice Address - Phone:207-646-5211
Practice Address - Fax:207-641-8151
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2021-10-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MEMD17055207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME6223338OtherCIGNA
MEAA70718OtherHARVARD
ME7996841OtherAETNA
ME1225057565OtherANTHEM
I60338Medicare UPIN
MEE400138008Medicare PIN
MEAA70718OtherHARVARD