Provider Demographics
NPI:1295732097
Name:PROKOPIUS, RONALD H (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:H
Last Name:PROKOPIUS
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 1:57 WATER STREET
Mailing Address - Street 2:
Mailing Address - City:BLUE HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04614
Mailing Address - Country:US
Mailing Address - Phone:207-374-3933
Mailing Address - Fax:207-374-3985
Practice Address - Street 1:57 WATER STREET
Practice Address - Street 2:
Practice Address - City:BLUE HILL
Practice Address - State:ME
Practice Address - Zip Code:04614
Practice Address - Country:US
Practice Address - Phone:207-374-3933
Practice Address - Fax:207-374-3985
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD16554208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME411910099Medicaid
MEME071901OtherMOUNT DESERT ISLAND HOSP MEDICARE PTAN
MEME0719Medicare PIN
I10947Medicare UPIN
MEME071901OtherMOUNT DESERT ISLAND HOSP MEDICARE PTAN