Provider Demographics
NPI:1770686800
Name:DEVLIN, JOHN T (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:DEVLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:144 STATE ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3776
Mailing Address - Country:US
Mailing Address - Phone:207-400-8500
Mailing Address - Fax:207-400-8508
Practice Address - Street 1:144 STATE ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3776
Practice Address - Country:US
Practice Address - Phone:207-400-8500
Practice Address - Fax:207-400-8508
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME010202207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME323000099Medicaid
051357Medicare ID - Type Unspecified
ME323000099Medicaid