Provider Demographics
NPI:1518966027
Name:WHITTEMORE, STANLEY L JR (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:L
Last Name:WHITTEMORE
Suffix:JR
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 1:110 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BUCKSPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04416
Mailing Address - Country:US
Mailing Address - Phone:207-469-7371
Mailing Address - Fax:207-469-7306
Practice Address - Street 1:110 BROADWAY
Practice Address - Street 2:BUCKSPORT REGIONAL HEALTHCENTER
Practice Address - City:BUCKSPORT
Practice Address - State:ME
Practice Address - Zip Code:04416
Practice Address - Country:US
Practice Address - Phone:207-469-7371
Practice Address - Fax:207-469-7306
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00017552207Q00000X
MEMD19942207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMD19942OtherSTATE OF MAINE
ME1518966027OtherNPI
WAMD00017752OtherMEDICAL LICENSE
WAMD00017752OtherMEDICAL LICENSE
WAMD00017752OtherMEDICAL LICENSE
MEMD19942OtherSTATE OF MAINE