Provider Demographics
NPI:1013988112
Name:CILLEY, RONALD
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:CILLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04009-1156
Mailing Address - Country:US
Mailing Address - Phone:207-795-6474
Mailing Address - Fax:207-647-6223
Practice Address - Street 1:15 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-1156
Practice Address - Country:US
Practice Address - Phone:207-795-6474
Practice Address - Fax:207-647-6223
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013568207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEC99278Medicare UPIN
MEMM5490Medicare ID - Type Unspecified