Provider Demographics
NPI:1720192586
Name:PETERNEL, WILLIAM MCFADDEN (DO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MCFADDEN
Last Name:PETERNEL
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 1:139 TROTTING TRACK RD
Mailing Address - Street 2:
Mailing Address - City:WOLFEBORO
Mailing Address - State:NH
Mailing Address - Zip Code:03894-4828
Mailing Address - Country:US
Mailing Address - Phone:603-387-4555
Mailing Address - Fax:
Practice Address - Street 1:300 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7027
Practice Address - Country:US
Practice Address - Phone:207-795-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2239207Q00000X
NH9404207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MERE 363402OtherMEDICARE PTAN:
NHF89343Medicare UPIN
NHPERE3634Medicare ID - Type UnspecifiedMEDICARE NUMBER