Provider Demographics
NPI:1962442467
Name:REINKE, DANIEL J (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:REINKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 UNION ST
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605
Mailing Address - Country:US
Mailing Address - Phone:207-664-5304
Mailing Address - Fax:207-664-5305
Practice Address - Street 1:50 UNION ST
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605
Practice Address - Country:US
Practice Address - Phone:207-664-5304
Practice Address - Fax:207-664-5305
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME014303207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME335410099Medicaid
20Z300OtherMED A - BHMH SWING BED
ME102380100Medicaid
ME201300Medicare ID - Type UnspecifiedMEDICARE A - BHMH
MM6517Medicare PIN
MEMM6517Medicare ID - Type UnspecifiedMEDICARE - PERS
MEMM651701Medicare PIN
MEMM651702Medicare PIN
ME200051Medicare ID - Type UnspecifiedMEDICARE B - BHMH
20Z300OtherMED A - BHMH SWING BED