Provider Demographics
NPI:1508136953
Name:DIDONNA, GEORGE JEROME (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:JEROME
Last Name:DIDONNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GEORGE
Other - Middle Name:JEROME
Other - Last Name:DIDONNA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:59 BLUEBERRY CV
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-6527
Mailing Address - Country:US
Mailing Address - Phone:207-653-6293
Mailing Address - Fax:207-846-4036
Practice Address - Street 1:59 BLUEBERRY CV
Practice Address - Street 2:
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-6527
Practice Address - Country:US
Practice Address - Phone:207-653-6293
Practice Address - Fax:207-846-4036
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME015723207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease