Provider Demographics
NPI:1538140520
Name:NIGHTINGALE, STEPHEN H (MD)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:H
Last Name:NIGHTINGALE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:37 COMMERCE PARK
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-3383
Mailing Address - Country:US
Mailing Address - Phone:207-667-2422
Mailing Address - Fax:207-667-0135
Practice Address - Street 1:33 SEAVEYS WAY
Practice Address - Street 2:# 2
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-3868
Practice Address - Country:US
Practice Address - Phone:207-667-2422
Practice Address - Fax:207-667-0135
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013394207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME124610100Medicaid
MEF33613Medicare UPIN
MEMM4393Medicare ID - Type Unspecified