Provider Demographics
NPI:1336101104
Name:BURGESS, DONALD R (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:R
Last Name:BURGESS
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 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:P.O. BOX 626
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9422
Mailing Address - Country:US
Mailing Address - Phone:207-282-9080
Mailing Address - Fax:207-985-8459
Practice Address - Street 1:3 SHAPE DR
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6601
Practice Address - Country:US
Practice Address - Phone:207-467-8983
Practice Address - Fax:207-467-8981
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0140972080A0000X, 2080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME248080099Medicaid
ME1041865OtherAETNA
MEMNT053OtherHARVARD PILGRIM
ME018435OtherANTHEM
NH30208022Medicaid
ME610036401OtherCIGNA
ME018435OtherANTHEM