Provider Demographics
NPI:1619084290
Name:PIERCE, BRIAN R (M D)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:R
Last Name:PIERCE
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:WEST ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04865-0129
Mailing Address - Country:US
Mailing Address - Phone:207-390-8570
Mailing Address - Fax:207-613-2954
Practice Address - Street 1:643 ROCKLAND ST
Practice Address - Street 2:SUITE C
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-5320
Practice Address - Country:US
Practice Address - Phone:207-390-8570
Practice Address - Fax:207-613-2954
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD15913207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEBP7811501Medicaid
MEH65022Medicare UPIN
MEBP7811501Medicaid