Provider Demographics
NPI:1245210731
Name:EASTMAN, HARVEY WILSON (MD)
Entity Type:Individual
Prefix:
First Name:HARVEY
Middle Name:WILSON
Last Name:EASTMAN
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 1:80 MAIN ST
Mailing Address - Street 2:CENTRAL PLAZA
Mailing Address - City:LIVERMORE FALLS
Mailing Address - State:ME
Mailing Address - Zip Code:04254-1529
Mailing Address - Country:US
Mailing Address - Phone:207-897-4345
Mailing Address - Fax:207-897-2321
Practice Address - Street 1:80 MAIN ST
Practice Address - Street 2:CENTRAL PLAZA
Practice Address - City:LIVERMORE FALLS
Practice Address - State:ME
Practice Address - Zip Code:04254-1529
Practice Address - Country:US
Practice Address - Phone:207-897-4345
Practice Address - Fax:207-897-2321
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME6112207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
EA042226Medicare ID - Type Unspecified
D79220Medicare UPIN