Provider Demographics
NPI:1477547909
Name:CERVENKA, ROBERT P (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
Last Name:CERVENKA
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 1:112 SANFORD RD
Mailing Address - Street 2:
Mailing Address - City:WELLS
Mailing Address - State:ME
Mailing Address - Zip Code:04090-5533
Mailing Address - Country:US
Mailing Address - Phone:207-641-8044
Mailing Address - Fax:207-641-8169
Practice Address - Street 1:112 SANFORD RD
Practice Address - Street 2:
Practice Address - City:WELLS
Practice Address - State:ME
Practice Address - Zip Code:04090-5533
Practice Address - Country:US
Practice Address - Phone:207-641-8044
Practice Address - Fax:207-641-8169
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6858207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH00000029Medicaid
NH4270144OtherAETNA NON-HMO
NH0104458Y0NH01OtherANTHEM
NHB86051Medicare UPIN
NH4270144OtherAETNA NON-HMO