Provider Demographics
NPI:1568674232
Name:WHITING BAY FAMILY MEDICINE, PA
Entity Type:Organization
Organization Name:WHITING BAY FAMILY MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:A
Authorized Official - Last Name:GODIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-733-2900
Mailing Address - Street 1:PO BOX 108
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:ME
Mailing Address - Zip Code:04691-0108
Mailing Address - Country:US
Mailing Address - Phone:207-733-2900
Mailing Address - Fax:207-733-2866
Practice Address - Street 1:125 US ROUTE 1
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:ME
Practice Address - Zip Code:04691
Practice Address - Country:US
Practice Address - Phone:207-733-2900
Practice Address - Fax:207-733-2866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013026207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME080170735OtherRAILROAD MEDICARE
ME025951OtherANTHEM BCBS
ME610130001OtherCIGNA
MEF14082OtherHARVARD PILGRIM
ME098154OtherAETNA
ME132790000Medicaid
ME098154OtherAETNA