Provider Demographics
NPI:1497972723
Name:SEARS, EDMUND HAMILTON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:HAMILTON
Last Name:SEARS
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 FODEN RD
Mailing Address - Street 2:WEST BUILDING, SUITE 103
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2327
Mailing Address - Country:US
Mailing Address - Phone:207-828-1122
Mailing Address - Fax:207-828-0188
Practice Address - Street 1:100 FODEN RD
Practice Address - Street 2:WEST BUILDING, SUITE 103
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2327
Practice Address - Country:US
Practice Address - Phone:207-828-1122
Practice Address - Fax:207-828-0188
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD12749208M00000X, 207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIES8249Medicaid
RI001828301Medicare PIN