Provider Demographics
NPI:1396739520
Name:DEXTER, WILLIAM W (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:W
Last Name:DEXTER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:301 US ROUTE 1
Mailing Address - Street 2:BUILDING C
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9701
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:272 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102
Practice Address - Country:US
Practice Address - Phone:207-874-2466
Practice Address - Fax:207-774-4625
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2011-03-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ME012670207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEP00641149Medicare PIN
MEE54056Medicare UPIN
MEP00113153Medicare PIN
MEMM653601Medicare PIN
ME080096027Medicare PIN
MEMM6536Medicare PIN