Provider Demographics
NPI:1508841941
Name:FAMILY MEDICINE ASSOCIATES OF WATERVILLE PA
Entity Type:Organization
Organization Name:FAMILY MEDICINE ASSOCIATES OF WATERVILLE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-877-7100
Mailing Address - Street 1:10 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4315
Mailing Address - Country:US
Mailing Address - Phone:207-877-7100
Mailing Address - Fax:207-872-6134
Practice Address - Street 1:10 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4315
Practice Address - Country:US
Practice Address - Phone:207-877-7100
Practice Address - Fax:207-872-6134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MM6019Medicare ID - Type Unspecified