Provider Demographics
NPI:1407827744
Name:ROY, HENRY III
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:ROY
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04009-1156
Mailing Address - Country:US
Mailing Address - Phone:207-647-2311
Mailing Address - Fax:207-647-6015
Practice Address - Street 1:25 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-1156
Practice Address - Country:US
Practice Address - Phone:207-647-2311
Practice Address - Fax:207-647-6015
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013173207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEF14344Medicare UPIN
MEMM4054Medicare ID - Type Unspecified