Provider Demographics
NPI:1376510057
Name:CALDWELL, GORDON THOMPSON JR (MD)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:THOMPSON
Last Name:CALDWELL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:77 BATES ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7637
Mailing Address - Country:US
Mailing Address - Phone:207-783-2300
Mailing Address - Fax:207-783-2439
Practice Address - Street 1:77 BATES ST
Practice Address - Street 2:SUITE 102
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7637
Practice Address - Country:US
Practice Address - Phone:207-783-2300
Practice Address - Fax:207-783-2439
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME012721208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
030495OtherBCBS
010424957OtherCHAMPUS
M52001OtherCIGNA
E19633OtherHARVARD PILGRIM
010424957OtherEMPLOY STANDARDS
010424957OtherTRICARE
2075723OtherAETNA
25012128OtherMEDICARE RAILROAD
ME272410099Medicaid
010424957OtherSTANDARD TAX ID
M52001OtherCIGNA
E19633OtherHARVARD PILGRIM