Provider Demographics
NPI:1710943378
Name:JEDERLINIC, PETER J (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:JEDERLINIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:76 HIGH ST
Mailing Address - Street 2:STE 300
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7649
Mailing Address - Country:US
Mailing Address - Phone:207-795-5544
Mailing Address - Fax:207-795-5645
Practice Address - Street 1:76 HIGH ST
Practice Address - Street 2:STE 300
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7649
Practice Address - Country:US
Practice Address - Phone:207-795-5544
Practice Address - Fax:207-795-5645
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME018700207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEC0713002Medicare PIN
MEC0713001Medicare PIN