Provider Demographics
NPI:1285867044
Name:EDWARD B KITFIELD III
Entity Type:Organization
Organization Name:EDWARD B KITFIELD III
Other - Org Name:WISCASSET FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:KITFIELD
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:207-882-6008
Mailing Address - Street 1:PO BOX 351
Mailing Address - Street 2:
Mailing Address - City:WISCASSET
Mailing Address - State:ME
Mailing Address - Zip Code:04578-0351
Mailing Address - Country:US
Mailing Address - Phone:207-882-6008
Mailing Address - Fax:207-882-7803
Practice Address - Street 1:66 WATER STREET
Practice Address - Street 2:
Practice Address - City:WISCASSET
Practice Address - State:ME
Practice Address - Zip Code:04578
Practice Address - Country:US
Practice Address - Phone:207-882-6008
Practice Address - Fax:207-882-7803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME008477207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME108450000Medicaid
MEMM5997Medicare PIN
MED03797Medicare UPIN