Provider Demographics
NPI:1598780330
Name:MADORE, PETER JOHN (PT)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:JOHN
Last Name:MADORE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 SYLVAN RD
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-4221
Mailing Address - Country:US
Mailing Address - Phone:207-401-4324
Mailing Address - Fax:207-401-4325
Practice Address - Street 1:82 SYLVAN RD
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4221
Practice Address - Country:US
Practice Address - Phone:207-401-4324
Practice Address - Fax:207-401-4325
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2307225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME048152OtherANTHEM ID
MEME0249Medicare ID - Type UnspecifiedID