Provider Demographics
NPI:1902836612
Name:CHODKIEWICZ, CATHERINE (MD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:CHODKIEWICZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 WHITING HILL RD
Mailing Address - Street 2:SUITE 21
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1021
Mailing Address - Country:US
Mailing Address - Phone:207-973-7478
Mailing Address - Fax:
Practice Address - Street 1:33 WHITING HILL RD
Practice Address - Street 2:SUITE 21
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-1021
Practice Address - Country:US
Practice Address - Phone:207-973-7478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91910207R00000X, 207RX0202X
ME018398207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271430200Medicaid
FL50126OtherBLUE CROSS BLUE SHIELD
FLI23120Medicare UPIN
ME50226YMedicare PIN
ME001568602Medicare PIN
FL50126ZMedicare PIN
FLP00311298Medicare PIN