Provider Demographics
NPI:1356328801
Name:SHEA, DONALD B (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:B
Last Name:SHEA
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 1:200 KENNEDY MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4526
Mailing Address - Country:US
Mailing Address - Phone:207-861-3025
Mailing Address - Fax:
Practice Address - Street 1:200 KENNEDY MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4526
Practice Address - Country:US
Practice Address - Phone:207-861-8030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH9714207RC0000X
MEMD18015207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30009637Medicaid
MERE4189Medicare PIN
MEP01025980Medicare PIN
NH30009637Medicaid