Provider Demographics
NPI:1982649943
Name:O'DONNELL, PETER B (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:B
Last Name:O'DONNELL
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 1:60 FOREST FALLS DR
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-6971
Mailing Address - Country:US
Mailing Address - Phone:207-846-2229
Mailing Address - Fax:207-846-5119
Practice Address - Street 1:60 FOREST FALLS DR
Practice Address - Street 2:
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-6971
Practice Address - Country:US
Practice Address - Phone:207-846-2229
Practice Address - Fax:207-846-5119
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME913501207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME007585OtherBLUE CROSS
MEM61431COtherCIGNA
ME2116601OtherAETNA
ME007585OtherBLUE CROSS
ME2116601OtherAETNA