Provider Demographics
NPI:1578509535
Name:RYDELL, DAVID JAMES (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JAMES
Last Name:RYDELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 MOUNT HOPE AVE
Mailing Address - Street 2:SUITE 620
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5691
Mailing Address - Country:US
Mailing Address - Phone:207-907-3650
Mailing Address - Fax:207-947-1360
Practice Address - Street 1:700 MOUNT HOPE AVE
Practice Address - Street 2:SUITE 620
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5691
Practice Address - Country:US
Practice Address - Phone:207-907-3650
Practice Address - Fax:207-947-1360
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO1749208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G11921Medicare UPIN
MM9790Medicare ID - Type Unspecified