Provider Demographics
NPI:1427043942
Name:MISKOVSKY, EMIL PETER (MD)
Entity Type:Individual
Prefix:
First Name:EMIL
Middle Name:PETER
Last Name:MISKOVSKY
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:C/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT
Mailing Address - Street 2:PO BOX 7291
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04243
Mailing Address - Country:US
Mailing Address - Phone:207-777-8950
Mailing Address - Fax:207-777-8800
Practice Address - Street 1:93 CAMPUS AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6030
Practice Address - Country:US
Practice Address - Phone:207-755-3636
Practice Address - Fax:207-755-3652
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420010255207RG0100X
MEMD19652207RG0100X
NY291445207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1007971Medicaid
VT58290OtherBLUE CROSS AND BLUE SHIEL
VT105305OtherMVP
VTSX3889Medicare PIN
VTE23683Medicare UPIN