Provider Demographics
NPI:1275570541
Name:STOCKWELL, RICHARD SYDNEY (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:SYDNEY
Last Name:STOCKWELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SCAMMON ST
Mailing Address - Street 2:SUITE 19
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-5121
Mailing Address - Country:US
Mailing Address - Phone:207-282-4704
Mailing Address - Fax:207-284-0088
Practice Address - Street 1:344 CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-2408
Practice Address - Country:US
Practice Address - Phone:207-854-8200
Practice Address - Fax:207-854-8244
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1589208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM7349Medicare ID - Type Unspecified
MEG72833Medicare UPIN