Provider Demographics
NPI:1255300844
Name:VAN ORDEN, JOHN S (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:VAN ORDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:430 BATH RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2637
Mailing Address - Country:US
Mailing Address - Phone:207-442-0350
Mailing Address - Fax:207-442-0355
Practice Address - Street 1:430 BATH ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011
Practice Address - Country:US
Practice Address - Phone:207-442-0350
Practice Address - Fax:207-442-0355
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2015-01-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ME009424207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME296600099Medicaid
ME296600099Medicaid
ME1006390001Medicare NSC
ME139340Medicare PIN