Provider Demographics
NPI:1235199332
Name:CABOT, RICHARD M (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:M
Last Name:CABOT
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 1:165 POPLAR ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MILLINOCKET
Mailing Address - State:ME
Mailing Address - Zip Code:04462-1235
Mailing Address - Country:US
Mailing Address - Phone:207-723-3003
Mailing Address - Fax:207-723-3006
Practice Address - Street 1:165 POPLAR ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MILLINOCKET
Practice Address - State:ME
Practice Address - Zip Code:04462-1235
Practice Address - Country:US
Practice Address - Phone:207-723-3003
Practice Address - Fax:207-723-3006
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME012431208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A60506OtherHARVARD PILGRAM HEALTHCAR
5770256OtherAETNA US HEALTHCARE
022323OtherANTHEM
MI200003Medicare ID - Type Unspecified
5770256OtherAETNA US HEALTHCARE
A60506Medicare UPIN